Transforming Immunization Supply Chain using Last Mile Data

The India StoryElectronic Vaccine Intelligence Network

April, 2017

SCALE

World’s Largest Immunization Programme

~27,000 facilities(95% sub-district)

~27M newborns~30M pregnant women~100M <5 years of age

>650M doses>9M immunization sessions

CONFIDENTIAL 4

Six-level Vaccine Supply Chain

Low resource environmentAnnual estimationsMonthly targetsDelivery and Pickup

70,000 CCEs27,000 CCPs

National Store / Manufacturer

State Store

Divisional Store

District Store

Taluk/Block

PHC/CHC

Vaccine Supply Chain Management Challenges

Non- Standardized Vaccine Stock Record-keeping

Diverse Terrain

Mismatch in Demand & Supply

No Real-time Visibility of StocksNo Real-time Visibility of Storage Temperatures

Barriers to Digitizing Vaccine Supply Chain

Electricity Supply

Availability of ‘Functional’

Computer

Availability of Data Entry Operator

InternetAccess

TECHNOLOGY AND DATARobust Technology & Simplified Procedures

Good Data

Mobile-cloud technology gives visibility into stock consumptionEnables optimal decisions to ensure stock distribution & availability

Temperaturesensors

Connecting first through last mile

National MoHFWCentral stores

State/Regional Stores

District Stores

PHCs/CHCs

eVIN

Support

Optimized Data Entry - Simple Tools - Contextual Analytics

Logistics Data: Physical & Digital

Temperature Data

• Temperature sensors sending temperature and device health over GPRS / SMS

• Multiple monitoring points – top, middle, bottom, ambient

• Hot/cold alarms, analytics on vaccine exposure & asset functioning

• Remote logger device management

Empowering Cold-chain HandlersHealth worker enters: - issues - receipts - stock counts - discards - orders

Health worker gets: - real-time stock views - alerts on low stock/expiry - optimal order recommendations - delivery status - temperature alarms - SOP reminders - general announcements

GPRS / SMS

Visibility and analytics at the last mile for the last mile

* Closed and open vials

Empowering Managers

Visibility and analytics at every level

Robust Technology for Low-resource Environments

Device heterogeneity VoiceGPRS SMS

Service Management Middleware

Transactions Events Locations Devices

Logistics AnalyticsHuman resources

Easy to Use – Web and Mobile

1. Inventory Management2. Order Management3. Batch & Expiry Management4. Demand Forecasting5. Replenishment Optimization6. Workforce Monitoring 7. Geo-tracking & Location services8. Transport Routing & Scheduling9. Integrated Temperature Monitoring10. Big data analytics & dashboards

Strong Human Resource Network

National CommitteeState OfficersRegional Managers

District Manager

Continuous feedback for health workers and officials in the network

9500+ village stores,500+ stores above

district

Big Data, Actionable Analytics

Per month> 2M transactions

> 80M temperature samplesQualitative feedback

> 20 major indicators

Footprint> 500GB of raw data

> 2TB of analytical data

Transformation

People, Information & Procedures

USAGE & TRANSFORMATION

System Strengthening & Improving Programme

Governance

Standardizing stock keeping

and distribution procedures

Strengthening cold

chain HR

Use of simple mobile based

application

Innovative use of

technology for temp.

monitoring

Real time stock and

temp visibility

Real Time Monitoring System

Real-time Visibility of Vaccine Data

SCALE

36 States And Union Territories

27,000 Vaccine Storage Points

56,000 Government Staff Trained

55,000 Temperature Sensors

650 Million Doses Tracked

DataVisibility Analytics

StockAt every store

Temperature & StatusOf every cold-chain equipment

DemandFrom each store

SupplyAt warehouse & in-transit

Stock abnormalityZero stock, < min, > max

Optimal replenishmentsConsumption based forecasting

Trends of nearly “everything”By time, product, location, …

Human PerformanceData quality, response times

Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-170

200000

400000

600000

800000

1000000

1200000

1400000

1600000

1800000

2000000

732673

998172

1367201

1635921

18045571869407

Digital Transactions

Digital Transactions

Digital TransactionsNearly 2 million every month

Madhya

Pradesh

Uttar Prad

esh

Gujarat

National

Rajasth

an

Jharkhan

d

Manipur

Chhattisga

rhBihar

Assam

Odisha

Nagala

nd0.0

20.0

40.0

60.0

80.0

100.0

120.0

98.7 97.8 97.8 97.1 96.9 96.7 96.5 95.6 93.7 92.1 85.8 83.9

% of CCP that have vaccine availabil ity index >90%

Stock Availability> 95%

Rajasthan

GujaratM.P.

Chhattisgarh

Manipur

Assam

Odisha

U.P.

JharkhandBihar

Nagaland

50

55

60

65

70

75

80

85

90

95

10093.53 93.93 94.68 94.86 96.49 96.49 96.53 98.11 98.34 99.69 100

Health centres updating their vaccine data on eVIN in the last 7 days

National %

Weekly Reporting Rate> 98%

• Moving to an “informed push” model• Consumption-based demand forecasts, flowcasting• Policy compliance & evidence-based advocacy-

Open vial policy compliance, vaccine stacking guidelines, capacity building, and so on

• Last mile decision-making based on eVIN data

Impact

Simple and robust technology and processes are essentialLow resource environments pose significant challenges to achieve high data quality from the last mile

Big and small data are both important, along with actionable analyticsHuman behaviors have to be changed towards timely actions, supported by highly usable supply chain analytics

Empowering people locally at every level drives better adoptionContextual analytics, accessible and usable (on computers or mobile phones), drives adoption and ownership at each level

Connecting people within and across levels enables good feedback loopsEnabling a human “network” that has good visibility makes them work together to solve problems

The model can scale cost-effectively only with robust technologyMobile and cloud-based computing technology has to deliver actionable analytics at all levels, esp. so at the last mile

Summary

Improved & Efficient Vaccination Systems