In Action: Supply System Digitalization

Background

Uganda's Ministry of Health (MOH) has implemented a Primary Health Care (PHC) policy since 2010. The policy focuses on the procurement, supply, and distribution of Essential Medicines and Health Supplies (EMHS) using a dual pull-push system. After more than eight years of investing in and experimenting with a pull system, the MOH decided to maintain the pull system for Health Centre (HC) IVs and Hospitals, while adopting the push system for rural and hard-to-reach lower-level health facilities, including HC III and HC II. This approach aims to minimize delays in the procurement of EMHS, reduce the risks of corruption in medicine procurement, and address chronic drug stock-outs at primary care levels, including HC IIs and HC IIIs. Additionally, the approach is intended to ease the burden on frontline health workers associated with the requisition of medicines and other health supplies.

Recently, stakeholders, including the MOH and donor agencies, have made concerted efforts to improve stock and inventory management and reporting. The MOH introduced RxSolution at higher-level facilities, such as Regional & National Referral Hospitals. This implementation has significantly improved aspects of stock and inventory management, especially concerning data quality. However, despite these efforts, most of the information remains siloed at health facilities and embedded within electronic Logistics Management Information Systems.

Our Intervention

The Digitization for Health project aimed to achieve the following objectives:

✓ Improve inventory management and reporting of essential drugs and medical supplies by digitizing these processes to ensure that there is sufficient and timely availability of these items to support the delivery of quality healthcare services. 

✓ Increase data visibility, reporting, and early warning mechanisms by implementing a digital platform for data collection and analysis to provide decision-makers with timely and accurate data to support effective decision-making.

✓ Strengthen the capacity of health sector staff in planning and supply management by providing training and support to build the capacity of health sector staff to effectively manage and utilize digital tools for planning and supply management.

Medical Access, in partnership with Signalytic, implemented a 2-year (2020-2022) United Nations Capital Development Fund (UNCDF)-funded project aimed at improving stock management of essential drugs and medical supplies at lower-level health centers in Uganda. The project aimed to provide a robust locally assembled digital stack that leverages internet and smartphone penetration in rural Uganda to address the most prevalent challenges to digitalization in the health sector such as hardware, cost, connectivity, and power.

MA and Signalytic developed and piloted S+ solution in 25 lower-level health facilities in Kiryandongo district in Uganda. The S+ Solution is useful to health facilities and other strategic tiers like MOH, international agencies, warehouses, private entities, and decision-makers within the sector by improving connectivity and facilitating expansion to other sectors beyond health like agriculture to facilitate traceability and visibility. The solution was designed to address challenges such as determining and maintaining adequate stock levels of essential medical supplies in lower-level health facilities through the development and deployment of a digital tool- the S+ solution.

With a  strong emphasis on interoperability and data security, S+ enables stock status reports, alerts, and reminders to strengthen the enforcement of good pharmaceutical practices such as First Expiry First Out (FEFO), advising on stock redistribution, monitoring commodity variances, min/max levels, and ordering, averting potential stock-outs and expiries through automated alarms to inform top-ups. The system users include District Health Teams who monitor stock levels at health facilities and authorize informed stock redistributions between health facilities, and health facility store in-charges and store managers who view stock data and alerts.

In addition, Medical Access installed solar-powered boxes and terminals at the health centers, which can communicate device health and any irregularities in battery/solar and cell service in real-time to ensure easy troubleshooting. The stock data generated is first stored locally on the micro server box via wifi and then transacted hourly across the network through a solar-powered Distributed Ledger Block Chain Technology that ensures end-to-end data encryption and can run on intermittent GRPS connectivity. Data bridges to databases such as Oracle, DHIS2, PIP can ensure timely read/write capabilities to the national stakeholders. Application updates are done remotely without the need for visits of IT personnel to the facility, and no action or out-of-pocket costs are required by the end-user.

Results

The new system maintained a 100% uptime and data synchronization between facilities. Preliminary data from the size of block graph estimates that the internet costs required for the entire district's data needs, including firmware updates, is about 4.3GB per year. This is significantly cheaper than the current 10GB provided to facilities per month to support stock status reporting by implementing partners. These system-wide efficiencies will create a more inclusive and robust health system, resulting in savings and efficiencies throughout the system, and freeing up valuable capital for investment beyond the ICT layer.