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1. CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia Information Communication Technology to Improve Commodity Security: The Case for Ghana’s Early Warning System A joint presentation by USAID | DELIVER PROJECT and USAID FRHP, Ghana at the Global Health Supply Chain Summit Addis Ababa – November 2013 Presented by Daniel Owusu-Afranie [SPEAKERS NAMES] [DATE]

2. Outline Why is logistics data needed for commodity security? What was the situation? What was done? What is the situation now? What are we going to do next?

3. Why is logistics data needed for commodity security?

4. Commodity Security I can obtain and use quality health supplies whenever I need them Commodity Security

5. Importance of Data for Commodity Security I am there when… • A functional and robust supply chain system delivers a reliable and continuous supply of health commodities to service delivery points. Commodity Security • A functional LMIS across all levels of the supply chain systematically collects, organizes, analyzes, and transmits logistics data for decisionmaking.

6. What was the situation?

7. What was the situation? Limited or no visibility of data on stock levels of program commodities at SDPs for decisionmaking because— • integrated LMIS was not available for public health programs • a non-functional vertical LMIS for public health programs was in place • there were delays in submitting logistics data • inventory data for CMS and 10 RMSs not connected in real time.

8. What was the situation? (continued) • No or incomplete stock status reporting from facilities for decisionmaking at higher levels • Irregular reporting and ordering not based on logistics principles (max/min, reorder levels) • Resupply decisions not based on actual logistics data from facilities, which lead to frequent stockouts, occasional overstock, and expiries at all levels (facility, RMS, CMS).

9. What was done?

10. What was done? To improve supply chain functioning, the USAID | DELIVER PROJECT and USAID Focus Regions Health Project (FRHP) collaborated with the Ghana Health Service (GHS) to use modern communication technology (mobile phones and computers) that would enhance― logistics data reporting visibility use.

11. What was done? (continued) • The collaboration resulted in the Early Warning System (EWS), a Short Message Service (SMS)-based stock reporting system. • It has operated in Ghana since June 2011.

12. The EWS The EWS provides near real-time stock status information for tracer commodities for prompt decisionmaking to avert stock imbalances, including low stocks, stockouts, and overstocks.

13. How it works • Facility worker enters stock counts into personal cell phone in the format: • COMMODITY[STOCK ON HAND]. [STOCK RECEIVED] • Send weekly stock counts as a text message (SMS) to toll-free short codes (ex., 1902 or 7000) • Web database via SMS receives and analyzes data; sends to managers via SMS and web.

14. Sending Data to EWS Reporting on Commodities mc24.0 mg0.45 ng35.50 dp80.0 jd10.0 cu12.20 Stock on Hand Quantity Received Commodity Code

15. EWS Information Flow Stores, Supplies & Drug Management Procurement & Supply Unit National Programs Central Medical Stores Regional Health Directorate Regional Medical Stores District Health Directorate Health Facilities Routine/paper flow of communication SMS messages EWS website access

16. Pilot Coverage • 27 tracer commodities—for malaria, family planning (FP), and HIV • FRHP: 88 sites—health facilities and regional medical stores in Central, Western, and Greater Accra regions • USAID | DELIVER PROJECT: 113 ART sites in the 7 other regions of Ghana • Conducted desktop and on-site monitoring • Conducted assessment after 6 months of implementation.

17. Assessment Results • Weekly reporting rates by facilities—84% and 78% was timely • Over 90% of health facilities were using bin cards for FP commodities and almost 80% were updated • EWS reports were consistent with 70% of bin card records available at facilities • Reduction in stockout rate: 32% to 24% • 29% of managers had registered and used the EWS website.

18. Facilities with Stockkeeping Records for FP Commodities

19. What is the current situation?

20. Current Coverage

21. What Reports Does the EWS Provide? • Weekly summary report of stock levels at all levels (facilities, RMS, CMS); including— • % of facilities with stockouts • months of stocks: stock status • reporting rates, including completeness of reports • Scheduled weekly e-mail reports for decisionmakers across all levels of the supply chain.

22. What Reports Does the EWS Provide? - Continued

23. Does System Generate Alerts and Feedback? • Reminders on Thursdays & Mondays • Acknowledgement of correct receipt of reports • Alerts for— • stocks at reorder level • stockout • overstocking • If facility does not report for 3 consecutive weeks, feedback sent to supervisor.

24. Does System Generate Alerts and Feedback? - Continued • Sends for stockouts and resupply of commodities from the RMS to all facilities in the system • If 50% or more facilities are stocked out of a specific commodity for 4 weeks, sends alerts to all managers in the supply chain system • Alerts if incomplete reports from facilities are sent for 4 weeks • Alerts decisionmakers who have not visited the site in 4 weeks to do so.

25. Reporting Rates

26. Ongoing Advocacy Efforts to Improve Decisionmakers Use of EWS • Key decisionmakers at all levels registered on the system to receive weekly summary reports • Continuous advocacy at all levels • senior managers’ meeting of the GHS at all levels • NAP+ meeting.

27. Assessing the Sustainability of the EWS—Objectives Load and stress testing of current system done in January 2013 to determine suitability for scale up to more facilities and for adding more commodities Availability of local expertise to manage the system after eventual hand-over to GHS Determine decisionmakers use of the EWS at all levels.

28. Sustainability Assessment—Findings Current system not ready to handle potential increased levels of web traffic and amount of data that may result from major scale-up to more facilities Local expertise not available to provide technical support to the system after eventual hand-over to GHS Limited use of system by managers at higher level.

29. Sustainability Assessment—Recommendations • Improve policymakers use of the system: • implement new reports and workflows on the web interface • provide continuous education for decisionmakers on how to and should use the information on the system • adopt a uniform chain of supervision in all the regions where the system is implemented.

30. Sustainability Assessment—Recommendations • Pre-emptively decide on a maintenance and support plan to accommodate future major scale up by— • modifying the code base to handle larger amounts of data and finding a local vendor to support the system OR • migrating to CommTrack, a cloud-hosted, turnkey, open source solution, which is maintained by a United States–based vendor.

31. What we intend to do next

32. Short Term Engage a contractor to implement new reports and workflows on the web interface Continue on-going advocacy by orienting all district directors of health service on the EWS Continue monitoring and supportive supervision efforts to improve reporting and use of the system.

33. Medium- to Long-Term Engage stakeholders within GHS and MOH to— • decide on a maintenance and support plan to accommodate future major scale up • decide on the role of the EWS in the current restructuring of the supply chain system in Ghana.

34. Conclusions Using real-time EWS stock status reports, supply chain managers or decisionmakers can answer these questions and others to make health products available: • Have all facilities in my geographic/program area reported according to schedule? • Does each facility have adequate stock of health products on hand? • If stock is low at a facility, is replacement stock available at the regional medical stores? • Are any facilities over-stocked? • Has the system strengthened stock management: bin cards, or other paper-based reporting?

35. Conclusions - Continued • Along with other innovations, the supply chain master plan aims to introduce an integrated automated LMIS for the health supply chain in Ghana. While discussions about implementing the plan continue, the EWS will ensure commodity security by providing data visibility for health commodities stock levels. • Mobile phones are readily available. A simple text message goes a long way toward improving supply chain management.

36. The EWS Website www.ewsghana.com

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