In Mozambique there are two distinct implementations of OpenLMIS
Vaccine Management: SELV (Sistema Electronica de Logistica de Vacinas)
Mobile Stock Management (other programs): SIGLUS (Sistema de Informação de Gestão Logística das Unidades Sanitárias)
SIGLUS: USAID Global Health Supply Chain Program – Procurement and Supply Management (GHSC – PSM)
SIGLUS: 4 provinces, 12 districts; 157 Health Facilities (as of Dec 2017)
Partners: VillageReach, USAID, GHSC-PSM, DPS, MISAU, CMAM, CHAI, UNPFA, ARIEL, CCS, CHASS, EGPAF, ICAP, FGH, FHI, MSF, UNICEF
Mozambique is a large country with numerous remote health facilities and highly-intermittent Internet access. For this type of environment, the ability for a software to operate offline is critical. As such, in 2014 VillageReach with support from the Mozambique Ministry of Health, selected the OpenLMIS platform to build a comprehensive vaccine supply chain system to support the Dedicated Logistics System (DLS) vaccine distribution program.
In Portuguese-speaking Mozambique, the customized implementation of OpenLMIS for vaccine management is called Sistema Electrónico de Logística de Vacinas, or SELV. Offline data entry is essential for Mozambique’s informed allocation (push) replenishment cycle, as many of the field coordinators collecting and then reporting data from remote health centers use workstations with intermittent Internet access. Consistent Internet connectivity in much of the country is a rarity, as fixed-line broadband service is prohibitively expensive and network infrastructure in rural areas is challenging. As such, the Mozambique health facilities use the more economical alternative: a cellular data modem that connects to GPRS service. This service can be intermittent and is typically slow, with high levels of latency and connection error rates.
However, because SELV allows for extended periods of offline data entry and then bursts of synchronization with the server when connected to the Internet, the use of 3G modems is an appropriate and scalable solution not just for SELV access via desktop but on tablets as well. By the end of 2014, SELV had been deployed to four provinces on desktop, laptop, and mobile devices, serving over 400 health centers and their combined 10 million patients. In 2016, an extended deployment to make SELV available to all regions began with a completion date in early 2017.
In resource-limited settings, medical commodity supply chains for public healthcare systems face a myriad of challenges, among them incomplete data about consumption and stock levels. In these settings, there is growing interest and uptake in using electronic logistics management information systems, largely focused on warehousing and distribution. This has provided improved visibility of data and more efficient supply chain management. However, access to data about stock movements at the health facility level remains as a gap in these systems. The Clinton Health Access Initiative partnered with ThoughtWorks, Inc. to develop an Android-based tablet solution for use by the Mozambican Ministry of Health (MoH)at the health facility level.
Through an agile development approach, the project expanded on the open-source OpenLMIS platform to include an Android application that captures key workflows at the health facility level including stock management, automated requisition orders, and alert algorithms for stock levels and expiries. The iterative development process engaged MoH stakeholders to ensure the system was built upon the correct business logic used in the Mozambican supply chain. Stakeholder use cases also informed the development of a web portal where real-time visibility over facility-level data is available for reporting, visualization, and analysis. A multi-center field pilot provided an opportunity to refine and improve the product based on user acceptance testing.
Over two years of development, piloting in an additional 09 health facilites, and evaluation, the mobile application and web portal were approved by CMAM for national scale-up in Mozambique.
Based on the success and lessons learned over the last two years, CMAM in conjunction with implementing partners, developed an implementation plan to scale SIGLUS implementations across targeted HFs, including the development of local and regional partners to ensure sustainability of SIGLUS.
Dates of deployment: 4 provinces in 2014; expanded to 11 provinces in 2016 – 2017 (except Nampula)
Health Centers: ≥ 1200
Program(s): Extended Program on Immunizations
Products: 20 (including 9 antigens, 5 syringes, diluents)
Dates of deployment: 2015-2017; 4 provinces in 2017; 2018+ wider scale-up leveraging additional funding partners
Health Centers: 1596
Program(s): ARV, Essential Medicines, Family Planning and others
Configuration: Mixed mode
Products: ARV, Essential Medicines, Family Planning and others
Logisticians collect data on visits made, cold chain equipment, EPI Inventory, EPI use, coverage rates (both child and adult) directly into SELV as they make distributions to facilities on their route.
This data is then exported to Tableau where the Tableau reporting engine creates powerful visualizations to assist logisticians optimize their distributions and react to issues.
Mozambique’s public sector LMIS is operated by CMAM and comprises several parts / levels:
Central Level: Central Medical Stores & three Regional WareHouses
Ferramenta Central – FC (Central Tool): The Ferramenta Central is a centralized database fed by MACS, SIMAM, and CMAM’s procurement information system (SIP). It is used by CMAM for creating distribution plans, conducting internal audits, and running M&E and ad hoc reports.
MACS: Warehouse management system used in the three CMAM central warehouses. MACS software capture stock on hand, stock movements (entries, issues, losses), and supply orders.
Provincial Level (DPM): 11 Provincial Warehouses and District Level (DDM): 147 District warehouses
Sistema de Informação de Medicamentos e Artigos Médicos – SIMAM (Information System for Medicines and Medical Supplies). SIMAM is an Access database installed at Provincial and District Medical Stores (DPM and DDM). It is also used in Mozambique’s central, general, and provincial hospitals. Sites use SIMAM to generate and send their monthly or quarterly requisition, including stock on hand, quantity issued, quantity received, adjustments, and quantities requested. Service delivery points also use SIMAM to report number of patients by regimen for ARVs.
Community Level: 1,596 Health Faclities
Paper requisition and balance forms: A large number of Helath Facilities use paper forms to report stock on hand, quantity issued, quantity received, adjustments, and quantities requested. Completed forms are sent from the health facility to the DDM. DDM staff then enters the data from the paper forms into SIMAM.
SIGLUS: A small number of health facilities (157) are using a cloud-based Logistics Management Information System for Health facilities (SIGLUS) to report stock data via tablets. As with paper requisition forms, SIGLUS data is sent from health facilities to DDMs to be synchronized into SIMAM.
In conjunction with the roll out, CMAM should focus on data quality as well and ensure data interfaces/exchanges between SIGLUS and FC; and SIGLUS and SIMAM are maintained (see figure above, Mozambique LMIS).
Transition in early 2017 of the project to CMAM with implementation partners USAID/PSM. Scale-up data show transition from 33 pilot sites to 157 implementation sites: the requisition volume increased significantly whilst the72 % on-time improved.
“The EPI data available via the paper forms at individual facilities matched perfectly with the aggregated data reported at the provincial level, reducing the time spent by district data managers correcting miscalculations. No other vertical program in the province had this level of data accuracy and quality.”