Supply Chain Frontiers issue #31. Read all articles in this issue.
One of the many challenges in delivering medicines and health supplies in sub-Saharan Africa is the lack of timely information about quantities of product flowing through the supply chain. Researchers at the Zaragoza Logistics Center are working with the Supply Division of United Nations Children’s Fund, UNICEF, to assess using mobile technology in Africa to improve supply chain information flows.
The lack of information limits product availability, impedes the introduction of new products and innovation in delivery channels, and stymies efforts to understand trends in disease patterns, product preferences, and treatment-seeking behavior. The problem also hampers efforts to improve health care systems.
The work will inform pilot projects that UNICEF plans to undertake later this year. The UN agency supplies large volumes of critical medical products, such as vaccines, anti-malarial medicines, and insecticide-treated bed nets to over 100 countries worldwide.
As a starting point, the team looked at real-world examples to better understand the approaches currently being taken in these challenging contexts. They found the following three particularly illuminating.
UNICEF Rapid SMS Pilot in Ethiopia
Faced with the possibility of famine following a drought in the south of Ethiopia, UNICEF Ethiopia launched a food distribution program to supply PlumpyNut food to undernourished children in June, 2008. The agency found that its ability to respond to demand was hindered by a lack of timely information on replenishment needs across its distribution network.
In late October, UNICEF piloted the use of basic mobile phones by existing field monitor personnel, to report product flows and status, and to send urgent stock-out alerts back to the capital. Each time a distribution center was visited, the field monitor sent a one-line SMS (short message service) text message that included the current stock balance, the quantity of PlumpyNut received, the quantity distributed, and the number of new beneficiaries during the current two-week reporting period.
The pilot identified a number of shortcomings. Only half of the distribution centers had cell phone coverage, a limitation that caused reporting delays of about one day. In some cases, the distribution centers were inaccessible. Data errors and overly complex data entry requirements also caused problems.
Novartis Mapping of ACT Stock Levels in Tanzania
Pharmaceutical company Novartis, based in Basel, Switzerland, is working with the Tanzanian Ministry of Health to develop and implement a system, called “SMS for Life.” The system will collect information on the current on-hand stock level of anti-malarial medicines (called artemisinin-based combination therapy or ACT) from all 4600 public health system posts/dispensaries in Tanzania on a weekly basis. The ultimate intent is that the logisticians within the public health system will use this information to improve availability of these medicines and hence reduce mortality rates.
The information will be sent via mobile phone SMS messages by health workers at the posts/dispensaries. As Novartis understands it, all 4600 health centers either currently or will soon have a basic cell phone and cell phone connectivity. The information will be collected in a central Web-based system, which will allow reporting on stock levels by zone, district, region and individual health post. The data will be available on-line, on paper, and displayed graphically via Google Maps.
VillageReach Northern Mozambique Project
From 2005 through 2007, the U.S. not-for-profit organization VillageReach implemented a project in Cabo Delgado, Mozambique that dramatically improved supply processes used to provide vaccines to 251 remote village health clinics.
Prior to implementation of this project, vaccination rates in Cabo Delgado were well below national averages. All health facilities experienced frequent stock-outs of critical vaccines and supplies, and 85% of the clinic refrigerators suffered from breakdowns and fuel shortages. The village health clinics in Cabo Delgado have neither cell phones nor cell phone coverage.
The VillageReach project uses teams of field coordinators who visit each health clinic monthly to deliver supplies, check inventories, service equipment, and provide simple training to resident health workers. While there, the field coordinator records in paper form information such as inventory stock levels, cold chain equipment status and healthcare services. The field coordinator then travels to the district office and enters the data so that it can be sent via Internet to the organization’s HQ in Seattle, WA, for analysis.
The project greatly reduced stock-out rates and dramatically improved vaccine coverage. Interestingly, stock-outs began to rise about a year after the project started, probably because the improvements stimulated demand.
A major implementation challenge was data accuracy – it took about 6 months of coaching of field coordinators to get “good data.”
The three examples point the way to further research on the use of mobile technology to improve health care in sub-Saharan Africa. First, how should data be communicated and where should the connectivity device reside? Second, can supply chains be designed that are robust enough to accommodate incomplete and inaccurate data? Third, how can the full set of information and logistical needs of each clinic best be covered? And finally, how can data collectors be trained and given incentives to assure timely reporting of accurate data?
The research is being conducted by Adjunct Professor Laura Rock Kopczak and ZLOG Masters student Simon Conesa. For more information, please contact Professor Kopczak kopczak@stanfordalumni.org .