TechNet21 English

[moderator]

Dear Moderator,

I'd be grateful to know if any of your readers have experience with use of
cell phones for transmission of cold chain stock position data from the
district level upwards. Kenya has started doing this, using purpose
developed software.

Best rgds,

Bob Davis
(email: robert.davis@africaonline.co.ke)
American Red Cross
Nairobi

[moderator]

Bob Davis shares with us more details on this interesting project. Many thanks.

He writes:

The project has thus far reached only 19 districts of Kenya, and we have only favorable user feedback by way of evaluation. Though it is early days, I think SMSg is probably on its way either to supplementing or (more likely) supplanting paper transmission of vaccine data from the periphery to the center.

SMS TRANSMISSION OF EPI DATA FROM FIELD TO NAIROBI


Meeting at American Red Cross, Nairobi, Saturday, 19 December 2009

Present: Gideon Nzoka
             Boubacar Dieng
             Fred Simiyu
             Ahmadu Yakubu

Nzoka is formerly a logistician with John Snow, especially logistics with public planning commodities, especially in reproductive health. They created a system where facilities and districts would form a report/request: balance, issues, distributions, balance at end of reporting period. This worked for contraceptives. He left JSI and set up his own company and developed software for other programmes.

With the Division of Vaccines and Immunization (DVI), the information flow through the hierarchy was too slow. There were, in many cases, no backup copies. Central Vaccine Store issued vaccines based on central stock in hand.

To remedy the speed problem, we created a system for reporting via SMS, with each SMS including the code of the facility, the reporting period, the antigen, balance, issues, receipts, and end balance. We created a software which takes the SMS data and puts it into a database. Sender at district level gets written confirmation of receipt. Once we have a few months' data, we would look at consumption history for each facility, then calculate monthly consumption for each antigen. For example, if a facility has given six reports, this generates average monthly consumption, most recent end month balance.

Central and Nairobi provinces, with a total of 19 districts, are the current participants. The launch was done in June 2009. DVI paid for funds to do the prototype. There was no donor funding, initially.

At the district level, we didn't have the resources to buy new computers, so we used existing infrastructure. The SMS goes to the DVI computer, which sends it to the district computer. All data go to a single phone number. The cell phone company doesn't know that they're participating! The reporting points can use any network to send their SMS messages.

It works in remote areas with satellite phones and no cell phones.

The sender has 7 variables to send for each antigen, plus syringes and safety boxes.

Since an SMS is 3 shillings, the cost to the district is probably less than through the post.

In Kenya, the districts have personnel to run the system. This is not so much the case at the provincial level. We use the district EPI logisticians.

DVI has absorbed all the costs, a total of Sh 3 million, or $US40,000. This is mostly start-up costs. Annual running costs are estimated at 10 percent of start-up costs.

Teething problems:

• Slow administrative response in Ministry.
  
• Scale-up takes time and involves the donors.
  
• Staffing issue because you train someone at the Ministry, and they move. To mitigate this problem, we train several people in each district and keep the training simple.
  

The data are received and handled by the personnel at the Central Vaccine Stores. We put the data in the server at DVI. However, the server is sometimes down at DVI, so we moved the server to Central Vaccine Stores, which has more reliable electrical supply.

The data received in Nairobi are sent back by confirmation copy to the district. However, the DVI staff in Nairobi are more skilled than some of the district staff.

The phone number sending the message has to be registered on the server.

The Central Vaccine Stores can use the system to send reminders to non-reporting districts.

Any evaluations to date?

The users are quite pleased, especially the feedback, which they don't get in the paper system.

All users can query balances from neighboring districts by SMS. Then, neighboring districts can negotiate directly to avoid stockouts. These data are not yet on the Internet/Intranet.

We have heard about reduced stockouts, but we don't have a large enough dataset to draw evaluative conclusions.

During the polio campaign, they used guesstimates of district OPV stocks, creating overstocking. This is the problem we are seeking to solve.

We have done the pilot phase in these 19 districts and did a quick evaluation. The Ministry is discussing an expansion, both to other provinces/districts and, in existing districts, down to the facility level.

COLD CHAIN INVENTORY

We are also going to set up a separate module to get cold chain inventory data. This means data from 264 districts, 6700 facilities. We are
negotiating the budget now.

Company has 12 staff. Biggest challenge is full time support. Going from 19 to 264 districts will be a challenge.

Discussion:

Boubacar: Would you come to Nigeria on a one-time basis, or leave staff behind?
Nzoka: We would prefer a turnkey operation.
Simiyu: How much attention does the system require from you after startup?
Nzoka: Incredibly little. When you see mistakes in incoming SMSs, you contact the sender immediately. That has been the main extent of our
support. We also had problems with nonfeedback when Nairobi server was down because of power cuts. Anyone with queries can send SMS text queries. The system permits DVI to send either individual SMSs or SMSs to all districts, e.g., roll-in of new vaccines.
Ahmadu: When a message is received, must someone update it manually?
Nzoka: No, this is automatic.
Ahmadu: Sometimes there is missing data. What do you do?
Nzoka: We do immediate response. 'You sent us the following data, which is incorrect. Pls clarify.' The users can register new phone numbers if they buy new cell phones.
Ahmadu: Is there a backup of what they have sent?
Nzoka: Yes, they are still doing the paper forms.
We cannot propose system changes at this stage.
Boubacar: Nigeria has the push system. When you reach the state, there is no pullNzoka: Converting from push to pull takes some time. You need information, and decision-making based on that information.
Davis: if this cheap system saves money in wastage, it will be cost effective.
Wastage over time would be a useful endpoint indicator, but we may not have good baseline data, at least in Kenya. However, we can easily monitor user satisfaction. Can we get data on frequency of stockouts?
Fred: If the data are incorrect, do you have to manually correct? Nzoka: DVI can either correct the data, or tell the sender to correct the data and resend. One guy sitting at the computer in Nairobi can solve most problems immediately.
The DVI guy is a logistician, not a data manager.
Ahmadu: In large countries, you need more people to handle that volume of data.
Boubacar: With rapid SMS, you need a contract with the cell phone company.
Nzoka: We are independent of the cell phone company in Kenya.
Another arm of the Ministry has approached me to set up a system for sending epidemiological data. We are discussing this with DANIDA; still in the talking stage.
Davis: Any discussions on transmission of routine vaccination data?
Nzoka: Not so far.
Boubacar: The dataset for vaccination data would be more onerous than for vaccine stocks.
Fred: You would need three sets of managers for vaccines, RI data, and epidemiological data.
Boubacar: What about data transmission just for AFP data? This would be doable, and high priority.
Davis: To justify costs of this system, small reductions in vaccine wastage are important when the vaccines are expensive. By the time that Nigeria could set up such a system, you would have several million dollars of penta and pneumo in the system. 
Nzoka: We would like free airtime as a contribution for this system. It would bring down the running costs.
Boubacar: Kebbi and Sokoto used SMSs in their last malaria campaign. No large scale EPI SMSg at this stage in Nigeria.
We need your company profile and CVs of your staff if we move forward, two steps down the road.