A driving force behind the creation of OpenLMIS was the need for an electronic logistics management information system (LMIS) that would not be encumbered by the same limitations found in systems historically available to the global health community. Central to this goal was the necessity for OpenLMIS to be a web-based system with additional offline functionality to best suit low-resource settings. (This, rather than a locally-installed software on each computer’s hard drive.)
For Mozambique, a country with numerous remote health facilities and highly-intermittent Internet access, OpenLMIS’s offline feature is critical, allowing users to enter data whether or not Internet connectivity is immediately available. As such, VillageReach, with support from the Mozambique Ministry of Health, selected the OpenLMIS platform to build a comprehensive vaccine supply chain system supporting the Dedicated Logistics System (DLS) vaccine distribution program. The system is now deployed in four provinces on desktop, laptop, and mobile devices, serving over 400 health centers and their combined 10 million patients. But from a connectivity and network perspective, what does it take to implement OpenLMIS in a country like Mozambique?
Internet Options in Mozambique
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.
Let’s get technical: The connectivity requirements for online mode in SELV are ideally about 240 kb/sec bandwidth, DNS delay of 250 milliseconds, and general ping delay at packets dropped around 5%. Other OpenLMIS implementations would require similar numbers, bearing in mind that this connectivity is necessary only when synching data back to the server.
Unlike LMIS applications that get installed on a user’s desktop workstation or laptop, OpenLMIS is entirely web based. This means there is no application to install on users’ computers, and there are no software patches, updates or upgrades that need to be installed on users’ workstations over the long term. For OpenLMIS, the only requirement for workstations is that they have a web browser installed. For the SELV system deployed in Mozambique, the recommendation was to use Firefox as the browser for desktop workstations. This was driven by three considerations:
- Following browser testing with SELV, Firefox was found to work best in terms of caching and bandwidth availability. (Chrome’s auto-update function hoarded the available GPRS bandwidth, restricting access to SELV during the browser’s frequent updates.)
- Many SELV users are not expert computer users but have previous experience with Firefox. It was best to remain with one browser that had the broadest familiarity within the users.
- Standardizing on a single browser would make it easier to answer users’ questions and troubleshoot any difficulties. This is particularly efficient for the region, considering that most technical support happens remotely. (Most often with personnel at the main Maputo office assisting with technical issues at the rural offices over the phone.)
SELV Goes Mobile
In addition to full implementation in four provinces (serving some 430 health units), SELV has also been deployed in a direct-to-digital trial with Android tablet devices. In this trial, field coordinators in Gaza province enter facility data directly into SELV using an Android Nexus 10, rather than collecting data on paper records and then later entering the data into SELV at an office workstation. The tablets run on Android OS, so the Google Chrome web browser offers the best functionality for the mobile SELV. Additionally, the tablet hotspot environment blocks all auto-update functions, solving the previous bandwidth availability issue with Chrome.
Because the Nexus 10 is Wi-Fi compatible, but not 3.5G compatible, Internet connectivity for the tablet is achieved by use of 3.5G modems connected to a TP-Link mini router. When connected to the 3.5G modem, the router creates a personal Wi-Fi hotspot that the tablet can connect to. For the trial, Field Officers were given a startup kit with a tablet, 3.5G modem, and battery-powered TP-Link router. Setting up the devices and training the users how to switch between offline and online modes in SELV took less than a day.
Let’s get technical: At the time of purchase (June 2014), the TP-Links cost $35 and the tablets cost $280. The Movitel 3.5G modems, purchased in Mozambique, ran around $30 each, with a monthly 1GB top-up cost of $20. Setting up each TP-Link and modem required upgrading the TP-Link firmware, setting the cell carrier APN, dialing the access number, and entering the (optional) SIM PIN. Tablet configuration included basic Wi-Fi setup on the router’s 3.5G network.
In addition to its highly-configurable architecture, OpenLMIS offers a variety of options regarding server deployment. For SELV, the most cost-effective and implementable option was deployment into the cloud. The entirety of SELV currently runs on one virtual machine in an Amazon data center in the US, and could easily be transferred to another cloud-based or physical server if so desired.
Let’s get technical: Rather than spending $10,000 on custom servers, one Amazon virtual machine in the cloud costs $20-$40 per month. (Based on available pricing in June 2014.) Even if SELV were expanded to serve all ten provinces in Mozambique, it would still only need the single virtual machine to run. Currently, the cloud server cost is paid by VillageReach, but would conceivably be a manageable expense for any Ministry of Health.
Overall, the simple requirements for server setup, Internet connectivity, and workspace readiness have contributed to a straightforward deployment of OpenLMIS in Mozambique. An efficient implementation has allowed more resources to be allocated for SELV website configuration, troubleshooting and user training, demonstrating the usability and scalability of OpenLMIS.