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.