Countries that are resource constrained face many challenges as they work to improve the health of their populations. Many new life saving health technologies have been invented or adapted and made available to help countries address the health challenges they face. One major challenge countries face is delivering vaccines, pharmaceuticals, and medical supplies to community dispensaries, health centers, and hospitals. There are multiple factors that impact the performance of the health logistics system but one key factor is poor process management and the information that provides line of sight to logistics performance. Strengthening the logistics management information systems (LMIS) is an important objective to improve performance in logistics, but it also has the potential to make the broader health information system stronger and benefit the overall health system.
The World Health Organization (WHO) through a network of global partners has been actively working to assist countries in health information system strengthening for many years. With support from the Bill & Melinda Gates Foundation the WHO formed the Health Metrics Network (HMN) in 2005 to develop methods and tools for strengthening health information systems (HIS) and to mobilize country stakeholders and donors to fund strengthening efforts. More than 65 countries completed national assessments and engaged in planning efforts for HIS strengthening only to discover there was a gap in the availability of appropriate solutions. Including LMIS solutions, available solutions were poorly designed with functionality limited to address only specific diseases. Further, the vast majority of these solutions lacked evidence of ability to scale beyond small pilots and fewer still were sustainable with national resources and supportable with local capacity.
The challenge of improving the design of scalable and sustainable solutions that could be applied across vertical disease programs was a challenge taken up by HMN partners including the Program for Appropriate Technology in Health (PATH), the Public Health Informatics Institute (PHII), and the Rockefeller Foundation. This led to the development of a methodology to collaboratively develop requirements that information systems would need to meet to be effective, scalable, and sustainable. This methodology drew heavily from industry best practices and more than 10 years of practical experience in public health by PHII in the U.S. The methodology is called the Collaborative Requirements Development Methodology (CRDM) and is heavily dependent on input from users, managers, and stakeholders that are directly engaged in the work of resourcing, delivering, and managing health services in low and middle income countries. Logistics management was the first health system domain to have requirements produced using CRDM. The first draft of these requirements was released in September 2010 in English with the French, Spanish, and Vietnamese versions released in December 2010.
The requirements as documented in this version were developed, reviewed, and refined by more than 330 users, managers, stakeholders, global, and national experts. Four countries were deeply engaged with the intent that the requirements would be common and applicable across this set of countries as well as be applicable for any health product, vaccine, or drug for any disease. The common requirements are public goods and intended to be widely distributed at no cost, with the primary audience being leaders and managers responsible for strengthening and managing logistics systems in-country, who seek to strengthen the LMIS to help them do it. The developers and implementers of LMIS solutions are the secondary audience, including suppliers who offer solutions that are commercial off the shelf (COTS), open source, or custom developed. The creation of OpenLMIS as a space where solution developers and solution seekers can connect is a logical and important step forward to broadly distribute these requirements as well as to improve them based on practical field experience.
While requirements are a solid first step they do not actually save lives until solutions are developed and deployed that ensure drugs and vaccines are provided to patients. OpenLMIS also provides a great opportunity to serve as a catalyst for solution development providing solution seekers with sound choices for meeting local requirements. Leaders in drug and vaccine logistics not only contributed to the common requirements but have continued to lead in field-based application of these requirements. Under the leadership of the WHO Expanded Program for Immunization and Essential Medicines Division and their partners like Project Optimize and USAID|DELIVER and Supply Chain Management System (SCMS) the requirements have been used to enable country-specific efforts to strengthen national LMISs. Worth highlighting is the case of Zambia where the Ministry of Health has applied the CRDM to adapt the common requirements into a local-specific set of requirements that are now being used to strengthen the national computerized LMIS. In less than 90 days local users, managers, and stakeholders collaborated to produce local requirements using the common requirements as the base and the CRDM as the methodology. Now leaders and managers in Zambia are proceeding to determine how their LMIS requirements can best be met in a way that is appropriate, scalable, and sustainable within the Zambian context.
It is our hope that we can accelerate the development of LMIS requirements and plans at the national level and move on to deploying solutions that work to improve the performance of the supply chain. We hope you agree and find OpenLMIS useful to catalyze and accelerate the development of real solutions that are appropriate, scalable, and sustainable.
David Lubinski is the Health Management Information Systems Portfolio Lead at PATH.