Improving Access to Vaccines through Digital Technologies

UNDP supports governments to harness the power of technology to digitalize national logistic management information systems (eLMIS) for improved storage, delivery and access to vaccines, medicines and other health products.

In India, UNDP is supporting the Ministry of Health and Family Welfare to digitalize vaccine supply chains with mobile technology. India is transforming the way vaccines are delivered to people, including vulnerable and migrant populations, for COVID-19 and the world’s largest universal immunization programme.

Electronic Vaccine Intelligence Network (eVIN)

eVIN is a smartphone and cloud technology-based app that digitizes information on vaccine supplies across India. Developed with support from Gavi, the Vaccine Alliance, eVIN enables vaccine handlers to report on available stocks, consumption levels and movement. It also has a SIM-enabled temperature logger for remote monitoring of storage temperatures, which are kept lower to preserve vaccines.

Data is stored in a cloud server that provides web-based dashboards and data analytics for programme managers and policymakers to view the information in real-time. This end-to-end visibility of key supply chain data allows stakeholders to effectively manage supplies and make decisions that ensure quality vaccines reach people on time.

COVID-19 Vaccine Intelligence Network (CoWIN)

The success of eVIN enabled India’s government to rapidly deploy CoWIN during the height of the COVID-19 pandemic. CoWIN was the country’s digital COVID-19 platform, which enabled patients to book appointments for vaccination and receive their vaccine certificates. It also provided vaccinators with a platform to manage vaccination sessions, develop reports and monitor progress, while allowing programme managers to monitor vaccine utilization, coverage and wastage throughout the system.
UNDP provided technical and implementation support for CoWIN. CoWIN reached more than 950 million people and enabled the expansion of vaccine coverage, including adolescents between 15 and 17 years. It registered over 36 million new beneficiaries and has supported the provision of a third vaccine dose to people above the age of 60, health workers and frontline workers.

Electronic Immunization Registry (U-WIN)

After the success of eVIN and CoWIN, India turned to its universal immunization programme, which is the world’s largest. In 2023, the programme will reach 29 million pregnant women and 26 million newborns annually to protect against 12 vaccine-preventable diseases, including tetanus, diphtheria, polio and hepatitis B.

To reach millions of people, India’s government designed U-WIN, a digital platform to e-register and track the vaccination status of all expectant mothers and children across India. U-WIN provides a streamlined information source, including a database accessible to all states and Union Territories for decision-making. U-WIN will also enable people to receive vaccinations anywhere in the country, ensuring that migrants can access them. In addition, the system will allow people to schedule appointments and track their vaccination history.

eVIN, CoWIN and U-WIN demonstrate how digital technologies improve supply chains and vaccine delivery, both for pandemic response and a stronger and more resilient system for health in the future.

Technology

The software platform employed for electronic Vaccine Intelligence Network (eVIN) enables real-time data capture at every level of the supply chain for the vaccine cold chain and provides end-to-end visibility of the entire process from central level to point of use. Last-mile supply chain and cold chain handlers at the peripheral level (e.g. health facilities) are provided with smart phones that are equipped with the eVIN application, which allows for the digitization of vaccines inventories. Information is recorded in offline mode at times of network unavailability and gets saved and uploaded through automatic data synchronization on the cloud network when the Internet is available again. These data are sent to a cloud-based server and are visible on a web dashboard on computers at any level of the supply chain for informed decision-making. Through customizable dashboards viewable through the eVIN web interface as well as a mobile version, managers can see information on stock inventory and demand information from each store, supply at warehouses and supply in transit and the status of all cold chain equipment, among other data. The tool also provides actionable data analytics, including on stock abnormalities, optimal replenishments through consumption-based forecasting, trends on a range of data and human performance, including data quality and response times.

For the immunization cold chain, in addition to providing real-time information on vaccine stocks, the system helps to track the storage temperature of vaccines. Subscriber identity module (SIM)-enabled temperature loggers attached to the cold chain equipment capture temperature information through a digital sensor placed in the refrigerator. The temperature loggers installed on all vaccine-storing refrigerators activate alarms and send messages to relevant authorities if the temperature in the fridge exceeds the set temperature limits. In the eVIN approach used in India, the vaccine logistics management, temperature monitoring and cold chain management are integrated into one system.

Governance

The technology component of electronic Vaccine Intelligence Network (eVIN) is complemented by strengthening governance systems. This includes ensuring that proper procedures and guidance are in place to streamline and systematize the use of the new electronic logistics management information system (eLMIS) software. eVIN helps to systemize record-keeping, for example by facilitating the distribution and use of standardized stock and distribution registers.

An equally critical element of promoting strong governance is fostering accountability at all levels of the supply chain to facilitate compliance with these standards, based on a sense of ownership over the data quality and outcomes of the system. From the development of standard operating procedures to the establishment of review and coordination mechanisms for implementation of eVIN, the streamlining achieved through these governance processes allows the best use of the eVIN-generated data and the ability to identify and address gaps as it is rolled out. This framework ultimately helps to catalyse data-driven action for vaccine supply management across all levels.

Human resources

The implementation of eVIN requires capacity-building of government vaccine and cold chain managers at all levels of the supply chain. Training is required to enable cold chain managers to use the technology at the regional, district and block and village levels until the last storage point, based on the tasks to be performed at each level. Formal training and on-the-job training are required to enable the use of this technology and to further integrate it in good storage practices and standard operating procedures. Training curricula are tailored to the functions and responsibilities of the vaccine handlers at each level of the vaccine supply chain. Cold chain handlers at the health centre level, often nurses in charge of immunization, are trained to use electronic Vaccine Intelligence Network (eVIN) to record data on vaccines stocks, consumption and temperature, which, through a cloud-based server, will be available to all cold chain managers and health officials.

Cold chain managers at the district level use data to provide constant support to immunization and medical officers to estimate vaccine requirements and distribution, supervise vaccine handlers and coordinate intervention of cold chain technicians to maintain and repair cold chain equipment. Health officials at the regional and central levels use this information to plan and optimize distribution, review national strategies to strengthen the vaccine supply chain and collect data on vaccine consumption and stocks for estimating vaccine requirements for procurement. The introduction of a new electronic logistics management information system (eLMIS) system requires not only initial training sessions, but also arrangements that will ensure regular oversight and availability of technical support to users at the health facility, district and central levels.

In India, the ingenuity of eVIN was not merely introducing a new software for LMIS, but also introducing a new staffing structure to manage the functioning of the eLMIS, as well as to reinforce compliance with existing standard operating procedures. In this way, eVIN creates a strong human resource network, connecting health officials and health workers across the immunization programme and encouraging increased accountability and positive behavioural change. The change management approach and human resource architecture established alongside the technology allowed eVIN to achieve the scope and sustainability of capacity-building required to empower those who drive the system, while facilitating close interface between personnel with information technology (IT) expertise and health programme experts to ensure that relevant field requirements are built into the software.

Learn more about the project and its results by visiting the UNDP India: eVIN project page . For more information about other eLMIS solutions that UNDP supports based on country needs, visit the eLMIS page.

[su_youtube url=”https://www.youtube.com/watch?v=8IP742Hn-Ig” title=”Smarter vaccine management, stronger health systems”]

This is an eight-minute video that explains how eVIN works and how India has adopted this technology across the entire vaccine supply chain to strengthen the country’s immunization programme.

[su_youtube url=”https://www.youtube.com/watch?v=askVgdifpnk” title=”e-Steps to a Healthy Future :: Encouraging Equity in Vaccine Availability
“]

A Data Revolution for Medical Supply Chains in Indonesia

Indonesia has a large population spread across many islands, which makes delivering vaccines more challenging. During the COVID-19 pandemic, UNDP and the Ministry of Health strengthened vaccination drives using SMILE, which was piloted in 2018 with Government of Japan support. SMILE is a mobile and web-based application that provides real-time visibility on vaccine stocks and storage temperatures and enables programme managers to monitor deliveries down to the last mile. It supports health officials to overcome constraints of infrastructure, data management and human resources, which often result in overstocking and stock-outs of vaccines. By making data readily available, SMILE facilitates decisions on vaccine distribution to reduce waste and address inequities in vaccine coverage.

To date, SMILE has facilitated the distribution of 454 million doses of COVID-19 vaccines to over 12,000 health facilities nationwide. Additionally, temperature loggers installed at 5,000 health facilities have maintained vaccine efficacy, thanks to support from Gavi, the Vaccine Alliance. Vaccine stock-outs have been reduced by 36% and over-stocking by 56%. Vaccine stock wastage has been reduced by more than 90%.

Following its use for COVID-19 vaccines, SMILE is now supporting national vaccination campaigns to increase children’s routine immunization coverage, which declined during the pandemic.

From SMILE to ME-SMILE

UNDP’s SMILE Project has been working with the ministries of health and the environment and forestry on an internet based medical waste management information system. Piloted in three health facilities, ME-SMILE uses Internet of Things technologies to track the waste removal process, including collection, sorting and disposal. Dozens of health workers received training to input data, enabling real-time analysis during the waste management process.

The digital tracking system allows health facilities and authorities to identify current streams and determine total waste generated and help reduce carbon footprint. ME-SMILE reduced waste processing time from three hours to 30 minutes, while providing health facilities with more accurate data to plan future disposal capacity.

UNDP and the health ministry are scaling up ME-SMILE in 2023, initially involving 30 major hospitals in four provinces. The long-term goal is to implement ME-SMILE in all 3,000 hospitals by 2025, ensuring the safe management of approximately 3,000 tons of medical waste daily and reporting waste management data from all facilities to the national level.

[su_youtube url=”https://www.youtube.com/watch?v=raIzPfhJ9Zw” title=”ME-SMILE Launch – Recap (English subtitle)”]

Combatting Malaria with SMILE

UNDP and the MoH, in collaboration with the Access and Delivery Partnership and the Global Fund, are piloting the SMILE Malaria app. This initiative supports Indonesia’s goal to eradicate malaria by 2030. With over 90% of malaria cases concentrated in the eastern provinces of Papua, West Papua and East Nusa Tenggara, the app digitizes the recording, monitoring and reporting of malaria logistics. By improving supply chain management and preventing stock-outs of malaria drugs and diagnostic tools, the SMILE Malaria app will contribute to malaria elimination efforts. The success of SMILE in immunization and malaria programmes will enable its scalability for monitoring essential drugs nationwide.

Over the past four years, UNDP’s SMILE system has revolutionized Indonesia’s digital logistics monitoring, bridging the digital divide and promoting digital innovation. The commitment of frontline health workers in utilizing SMILE has played a crucial role in informing decision-makers with critical health data. By leveraging SMILE’s capabilities, Indonesia is bolstering its health system preparedness and resilience and taking significant steps toward achieving universal health coverage, ensuring the effective delivery of life-saving vaccines and essential logistics to all its citizens.

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