The 6th Global Health Supply Chain Summit
Stronger vaccine supply chains through better
information on cold chain equipment inventories
Ahmad Abdulwahab and Richard Anderson
November 18–20, 2013
Addis Ababa, Ethiopia
About PATH
PATH transforms global health through innovation.
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Acronyms
CCEM
CDC
CCEI
CCL
CHAI
DHIS2
EPI
HISP
HMIS
MOH
PRRINN
UNICEF
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Cold Chain Equipment Manager tool
US Centers for Disease Control and Prevention
Cold chain equipment inventories
Cold chain and logistics
Clinton Health Access Initiative
District Health Information Software 2
Expanded Programme on Immunization
Health Information Systems Programme
Health management information system
Ministry of health
Partnership for Reviving Routine Immunization in Northern Nigeria
United Nations Children’s Fund
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A new tool to support EPI: DHIS2/CCEI
Web-based cold chain equipment inventories
18 November, 2013
Ahmad Abdulwahab,PRRINN-MNCH
Richard Anderson, UW, PATH
Sophie Newland, PATH
Fahad Pervaiz, UW
Overview
Objective
Introduce DHIS2/CCEI, a new tool that can support a stronger cold
chain and logistics systems by increasing access and use of cold chain
equipment inventory data for decision-making at all levels of the
vaccine supply chain.
Structure
Slides 6–9 provide an overview and framework for CCEI.
Slides 10–11 introduce data standards for CCEI.
Slides 12–15 discuss web-based systems and the DHIS2/CCEI module.
Slides 16-19 summarize the deployment in Northern Nigeria
Assumptions New vaccines are being added to the vaccine supply chain and
insufficient cold chain equipment is a major, preventable bottleneck.
Better equipment management and planning increases the efficiency
and effectiveness of the vaccine supply chain.
Investing in tools and systems that provide data for management
decisions will benefit staff throughout the cold chain and logistics
system.
An open-source software platform that is web-based offers EPI an
opportunity to increase data use and access.
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What questions do we want to answer with CCEI?
Where are refrigerators and facilities located?
What are the cold chain capacity requirements of each facility?
What is the size, age, and functional status of a country’s cold chain
equipment inventory?
How many refrigerators need to be repaired, replaced, or repositioned?
How may old refrigerators need to be replaced?
Are existing refrigerators big enough for the facility’s vaccine volumes?
What is the new cold chain equipment list and budget needed to support
planned introduction of new vaccines?
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Cold chain equipment inventories: Data sets
1. Health facility data
2. Refrigerators, freezers, cold room, cold box data
3. Vaccine and equipment reference data
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Cold chain equipment inventories (CCEI)
A brief history
In 2007, EPI, PATH, UNICEF, and WHO staff started a collaboration to
develop a CCEI tool to help countries develop evidence-based multiyear
equipment plans, CCEM. CCEM has since informed the design of a new
web-based CCEI tool, DHIS2/CCEI.
Draft CCEI Data
Standards
UNICEF CCL Taskforce provides
the consensus-building forum
for drafting CCEI data
standards.
The way forward
EPI/UNICEF/PATH/HISP
Initially working with EPI teams in Ghana, Kenya, Laos,
and Nigeria, UNICEF, PATH, and HISP will validate and
release the DHIS2/CCEI module as part of global DHIS2
platform, v2.13 (anticipated, Q1 2014).
Re-engineering of CCEM onto DHIS2 platform
In collaboration with HISP India, PATH translated lessons
learned from CCEM design and deployments into
specifications for a web-based CCEI tool that can
integrate with a national HMIS system, DHIS2.
Power of integration and extensibility
DHIS2/CCEI will be customized and maintained by MOH
as an integrated HMIS module and extended to support
temperature, monitoring, repair services, and other EPI
requirements.
DHIS2/CCEI: Web-based
CCEI tool integrated with
HMIS
2007
2008
CCEM: Stand-alone
Microsoft Access-based
CCEI tool
2009–2010
2011
2012
2015
2014
CCEM 2.1
Functionality and interface
expanded based on feedback.
CCEM 1.0
Uganda EPI, WHO/AFRO, UNICEF
and PATH validate CCEM 1.0.
UNICEF/PATH
MOU
Launch of CCEM
design and
development.
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CCEM in 10 countries
Kenya, Malawi,
Zimbabwe
Deployment of CCEM with
support from WHO, UNICEF,
CHAI, and CDC.
CCEM has been deployed in ten
countries in Africa, Europe, Latin
America, and Southeast Asia.
Anticipate continued use by country
EPI teams uninterested or unable to
support web-based CCEI.
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Contributions
Cold chain equipment inventory data standards:
•
CCEI standards vetted by UNICEF CCL Taskforce.
Web-based CCEI tool:
•
Cold chain equipment inventories added to DHIS2.
Vision for cold chain information system:
•
Linking multiple capabilities to support immunization supply
chain.
Deployment:
•
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PRRINN CCEI/DHIS2 deployment in Northern Nigeria.
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Developing a data standard for CCEI
•
•
•
•
•
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Agree on what
information needs to be
included.
Agree on the
representation.
Allow different
applications to share
data and interoperate.
Give countries flexibility
in choice of tools.
Draft reviewed by
UNICEF CCL Taskforce.
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Why data standards?
“[Data Standard] can avoid vendor lock-in, support new modular
solutions which interoperate with an installed base of technologies
and devices, and open the door for lower-cost providers (some
based in developing countries themselves) to take part in health
technology innovation without needing to create and manufacture
an entirely new platform.”
Masum H, Lackman R, Barleson K. Developing global health technology standards: what can other industries teach
us? Globalization and Health. 2013;9(1):49. Available at: http://www.globalizationandhealth.com/content/9/1/49
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Web-based information systems
Centralize data
management:
•
•
Robust, high-performance
database (cloud or server).
Link to national health
information system.
Distribute access:
•
•
•
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Enable update of CCEI.
Access to management
information at all levels of
health system.
Integrate with mobile
devices and reporting.
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District Health Information Software 2 (DHIS2)
•
Web-based health
information system
developed by HISP and
deployed globally.
•
Sophisticated system for
health indicator
reporting and data
visualization.
•
Highly customizable by
domain and country.
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Cold chain module for DHIS2
•
Release as a component
of DHIS2.
•
Under development by
HISP India.
•
Release target of
January 2014.
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CCEI vision
Align multiple software tools supporting immunization:
•
•
Conversion between different inventory tools: spreadsheets, PC
applications, and web-based tools.
Share data across applications: modeling tools, logistics
management.
Facilitate the process of building a national CCEI:
•
Tools for data integration and cleaning.
Extension of CCEI data standards to other cold chain domains:
•
Remote temperature monitoring.

•
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Reporting of 30-day temperature recorders in Laos with UNICEF.
Equipment maintenance.
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Background on Northern Nigeria
•
•
PRRINN-MNCH works in 4
Northern Nigerian states of
Jigawa, Katsina, Yobe and
Zamfara.
Combined population of the 4
states is about 20 million people
(92 LGAs, 976 Political wards with
about 3,500 HFs)
•
•
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Region has the worst health
indices –immunization inclusive in the country
• GAVI also plans to provide
1,400 direct drive solar
New vaccines introduction
refrigerators to the country
currently ongoing country wide
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Information system requirements
•
•
•
Huge demand for up to date data on CCE for
effective planning and monitoring
Although DHIS2 is widely used in the country,
data on CCE and vaccines stock not part of the
datasets (only coverage data)
Strong need for integration of Cold chain (and
vaccines) data with immunization reporting
•
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Addition of CCEI module will accelerate the
adoption of the DHIS2
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Implementation in DHIS2
•
•
•
•
•
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Flexibility of the DHIS makes
it easy to add-on the CCEI
module
Datasets customized to
meet the needs of the
country and the states
Data-elements in the IRP
matched with those of the
DHIS2
Incorporation of CCEI and
vaccines data linked to
immunization coverage data
has improved the
acceptability of the DHIS.
Limitations – no major ones
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Country opportunities
…For deployment of the CCEI
• Ongoing introduction of Pentavalent vaccines
• Ongoing plan to supply CCEs – 1st tranche of 1400
direct drive SR (GAVI) due by February 2014.
• Saving One Million Lives (SOML) campaign
• Development of Logistics Management system
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All photos in this presentation unless otherwise indicated are courtesy of PATH.
Support for this project is made possible by the generous support of the American
people through the United States Agency for International Development (USAID)
under the terms of the HealthTech Cooperative Agreement # AID-OAA-A-11-00051.
The contents are the responsibility of PATH and do not necessarily reflect the views
of USAID or the US Government.