Mozambique
Mozambique
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)
Year Deployed:
SELV: 2014
SIGLUS: 2015
Implementing Partner:
SELV: VillageReach
SIGLUS: USAID Global Health Supply Chain Program – Procurement and Supply Management (GHSC – PSM)
Deployment Coverage:
SELV: Nationwide
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
Situation
SELV
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.
SIGLUS
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.
Over two years of development, piloting in 09 health facilities, CMAM officially adopted the system as the only eLMIS to be rolled out to all health facilities of the country and renamed the program the Sistema de Informação para Gestão Logística nas Unidades Sanitárias (Logistics Management and Information System for Health Facilities). Most commonly known by its Portuguese acronym, SIGLUS, the software automated much of the inventory tracking, calculations, cataloging, and requisitions and electronically mimicked and automated the former paper-based system.
In 2017, the pilot program’s support transitioned from CHAI to the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project.,
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.
To learn more, consult the Technical Report: Seeing through the Cloud by the USAID GHSC Program
Full Project Scope – SELV
Dates of deployment: 4 provinces in 2014; expanded to 11 provinces in 2016 – 2017 (except Nampula)
Provinces: 11
Health Centers: ≥ 1200
Program(s): Extended Program on Immunizations
Configuration: Push
Products: 20 (including 9 antigens, 5 syringes, diluents)
Full Project Scope – SIGLUS
Dates of deployment: 2015-2017 (Piloting);
2017-2021 (on-going expansion); coverage of total 11 provinces in 2021; 125 Districts; 1321 HF.
Provinces: 11
Health Centers: 1580, with coverage of 84% (1321 HF) by end of February 2020
Program(s): ARV, Essential Medicines, Family Planning and others
Configuration: Mixed mode
Products: ARV, Essential Medicines, Family Planning and others
Integrations/Interoperability
SELV
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.
SIGLUS
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 (Future in OpenLMIS) – 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: 1,580 Health Faclities
- Paper requisition and balance forms: A small number of Health Facilities (259 HF) 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 total of 1321 HF in Mozambique 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. Here is more on success of SIGLUS
In the future, the integration of the system with the rest of the IS in the supply chain will look like this
Key Performance Indicators – SELV
Key Performance Indicators – SIGLUS
1. Requisition Reporting rate (December 2019 – December 2020)
2. SIGLUS Coverage as of February 2021
“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.”
