ICTworks

The Federal Ministry of Health has identified several key challenges for the healthcare system in Nigeria to ensure the availability of life-saving commodities and meet national supply chain reliability goals, including:

• Incomplete and inadequate data on commodity turnover at Public Health Centers,
• Late drug and medical supply deliveries to health facilities,
• Substantial degrees of stockouts in local stores.

For example, in 2014, some Kano local stores experienced stockouts (exhaustion of vaccines) of one or more antigens and devices 90% of the time. The stockouts substantially reduced Nigeria’s ability to meet immunization goals and illustrated the challenges facing Nigeria’s healthcare infrastructure.

In order to overcome these challenges, the Federal Ministry of Health wanted to have consistently sufficient stocks of vaccines and devices on hand. Additionally, a separate key goal was to have real-time stock data management in order to provide rapid response to shortages.

VDD and MOVE to the Rescue

To address these challenges, in 2014, eHealth Africa began building a suite of mobile applications, Vaccine Direct Delivery and MOVE, in collaboration with the Kano State government. Using both, health workers can bypass the traditionally slower paper-based reporting system, submit emergency notifications such as vaccine stockouts to government health workers for quick response, and report routine immunization such as the working statues of cold chain equipment, vaccine waste counts and the incoming and outgoing vaccine deliveries.

• Vaccine Direct Delivery is a data collection mobile application that works offline and is built specially to aid drivers during delivery to last-mile health facilities. The application automates the process of paper-based entries, captures the quantity of vaccines delivered and the quantity of vaccines on-hand at health facilities, and allows for entries of signatures of the receiving officers.

• MOVE aggregates all information inputted by HCWs to a web application dashboard where data is presented in one snapshot to governmental officials for streamlined action and planning. It is crucial as it ensures health facilities can run monthly polio and routine immunisation clinics across Northern Nigeria.

Lessons Learned

2015 was the launch year of VDD and MOVE in Kano and Bauchi states in Northern Nigeria. We’ve had great success with the four million doses of lifesaving vaccines delivered through VDD to health facilities, and we’re excited that stockouts have dropped from 90% to less than 30%. Yet scaling MOVE to 353 health facilities has not been without challenges. We’ve learned:

1. Building solutions for communities in a developing setting with deficits in infrastructure, technology and skilled manpower comes with its own unique set of challenges. Significant time was required to engage with various stakeholders, to understand their challenges, and to manage their expectations. One of the lessons learned here involves engaging with staff from the local community in discussions and meetings to help bridge communication, cultural gaps, and also give a sense of ownership in the project stake; this practice also helped to build trust with stakeholders involved at every stage of the process.

2. Behavior change is not easy, nor does it happen overnight, as most health workers were experiencing difficulties when transitioning from the paper-based system to the digital form of reporting. However, continuous user support (trainings and 24/7 Help Desk support) and regular field visits helped mitigate shortcomings arising from the transition process and thus facilitate a more permanent behavior change in the Kano State vaccine supply chain.

3. Major version upgrades require users to manually update VDD/MOVE from Google Playstore, to capture latest changes and in some instance be able to submit reports. As such, the need to get health workers to consistently update the application is crucial. This has helped us understand the need to continuously inform and prompt health workers to update the application, which we did through phone calls before and after every new release to make sure all users are up-to-date.

Written by Geerd-Dietger Hoffmann, Mohammed Samir Abubakar, Yusuf Umar, Natalya Nepomnyashcha and Tanlyn Roelofs of eHealth Africa