eIMS

Supply chain system for rural health facilities



Goal


Guarantee supply of life-saving medicines at rural health facilities, starting in Uganda




Role


Project lead, product owner and head designer. I worked closely with government officials, health workers, private sector companies, and the open-source community to design and implement the project. I also managed a team of engineers, public health experts, and designers to implement the project.




Learnings





Solution


Electronic Inventory Management System (eIMS). A open-source, comprehensive system to track and manage health commodities (i.e. drugs, syringes, condoms) from the central to rural health facility level.

It’s built on an active open-source system called OpenLMIS but customized for Uganda-specific workflows and regulations. Then we designed and deployed new infrastructure (connectivity, power), workflows (service design for health workers and reporting bodies), and technology (tablet and paper systems for tracking inventory flows) for use at the health facility level.


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Android tablet app for facilities

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Procurement planning and forecasting tool

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Inventory tracking feature



Problem


Supply chain for health is hard in lower-to-middle-income-countries (LMICs), and most public health systems experience “stock outs” (i.e. patient with X can’t receive medicine for X) of key medical supplies at health facilities.

It's also difficult to forecast inventory and manage contracts with suppliers (ex. pharmaceutical companies). In fact, many times a stock out occurs because someone has placed a drug order against an expired supplier contract!

Few countries with free public health systems have real-time access to data at health facilities. Many employ pen and paper with monthly reporting. Infrastructure (internet, power) is hard and tech interventions (complex tablet apps, SMS reporting) often fail due to poor design.




Process


Research

We divided our research between two focus areas, in Uganda:
1. Central warehouse and distribution center: Our goal was to understand the organizational and system design for ordering, tracking, and distributing medical inventory. We developed relationships with government works and the private sector suppliers to better understand improvement opportunities.
2. Rural health facilities and workers: focused on understanding the current processes and constraints for tracking inventory. We leveraged intercept interviews and assorted design tools to create health worker personas. And through numerous site visits and weeks of research, we also grew to better understand the infrastructural (power and connectivity — and resources to fund both) constraints for any proposed solutions.

In parallel, I coordinated market and “desk” research to understand how others had hacked at the problem. Our team aggregated insights from other countries by talking to assorted technology and public health implementers.

Prioritization

We then reviewed the research with stakeholders at a series of workshops, and aligned on the following implementation plan for improving the supply chain system:
1. Improve central systems for key problem areas (contract management, forecasting)
2. Coordinate infrastructure improvements at facilities
3. Pilot end-to-end system regionally
4. (I left before this step) Align on more comprehensive central system (ex. ERP)
5. Deploy system nationally

Implementation

We began our design efforts with procurement and forecasting and built a tool to automate a lot of the manual work already done. In parallel, a separate team helped the contracting department to refine their processes for managing supplier contracts.

We launched both tools in parallel with a change management process and immediately started to see a significant decrease in stock outs. Then we started prototyping more comprehensive solutions (ex. A full ERP) for managing all processes at the central level).

Once we established a control data set for central improvements, we moved to focusing on the end-to-end system. This required a deeper analysis of infrastructure and human resource hurdles and coordination with different funders.

We worked with a few parties to prototype a tablet and mobile solution in parallel to the existing pen-and-paper inventory management system. After assessing results, we opted to slowly roll out a tablet system (Android, tied to OpenLMIS but compatible with larger ERPs) to enhance ordering and tracking capabilities at the facility.

And the tool is being used in several other countries as well!


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Regional health facility storage area

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Prior pen-and-paper system

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Some regions had existing, proprietary tech