The better the question
Can you turn smart phone penetration into smarter inoculation?
Supply chain and logistical challenges were impeding immunization
It is a sad truth that while substantial progress has been made in lowering child mortality levels around the world, there remain huge numbers of young children who fail to receive the vaccines or preventative medicines they need to live long and healthy lives.
Overcoming the barriers that impede the delivery of such vital medicines is fundamental to solving this issue. And doing so means reaching local communities in remote, inaccessible regions around the world. So how can we optimize supply chains and distribution networks to effectively deliver vaccines to children in rural areas?
For a country where more than two-thirds of the population live in rural areas, this is a particularly acute issue. India not only has the largest number of births per year, at approximately 27 million, but also the largest number of under-immunized children in the world.
According to a UNICEF report from 2016, around 1.26 million children below the age of five die in the country every year and 57% of the deaths are caused by prematurity and neonatal infections.
To address this, the Indian Government launched the Universal Immunization Program (UIP), the largest undertaking of its kind in the world. Initially rolled out in 1985, the ambitious project ultimately plans to cover all 707 districts of India. This involves establishing a network of 27,000 vaccine storage centers, training more than 56,000 staff and procuring 650 million vaccine doses.
While the immunization initiative has achieved some positive impact over the past 30 years, it has been spread unevenly across the country. In 2011, the proportion of under-fives who were vaccinated exceeded 70% in only 11 states, and dropped below 53% in the eight most populous states.
Much of the problem revolved around lack of efficient supply chains and logistic systems. Reaching remote areas of the country where there is limited infrastructure and diverse terrain was exceptionally difficult, and vaccines were wasted in the process. When transporting vaccines, it is critical they remain at the correct low temperature, otherwise they go off. In 2015, over 25% of the vaccines procured went to waste before reaching doctors.
This posed a major challenge for the government: how to create a vaccine distribution mechanism that can effectively manage the transportation, tracking and safekeeping of vaccines from the point at which they are purchased to the point they are administered.
The better the answer
Real time data on vaccine stocks and storage, managed by smartphone
Using technology to support India’s Universal Immunization Program
In response to this challenge, India’s Ministry of Health and Family Welfare worked with the United Nations Development Program (UNDP) to develop and launch the electronic vaccine intelligence network (eVIN) in 2015 with assistance from the Global Alliance for Vaccines and Immunization (GAVI).
eVIN is designed to provide real-time information on vaccine stocks and flows, and control storage temperatures at all the cold chain facilities across India’s states.
The ambition of the eVIN initiative is a natural fit with our commitment to building a better working world, so we were selected by UNDP, along with our consortium partners, to support the initial roll out of eVIN in India’s three largest states, covering about one-third of the country’s population. This meant our teams had to work with UNDP to develop a way to not only tackle huge logistical and management challenges, but overcome the numerous barriers to reliably collecting digital data throughout the country.
“eVIN is a key initiative that really helps in improving the efficiency of the vaccination system throughout the country," says Marina Welter, Deputy Country Director, UNDP, India. "For the UNDP, it is a key piece of work because it not only works on processes, it also works on people and on infrastructure. And tying those three elements together will really help to take vaccinations throughout India a huge step forward.”
For the UNDP, [Evin] is a key piece of work that will really help to take vaccinations throughout India a huge step forward
Making the most of mobile
While India’s transport infrastructure has struggled to keep up with the pace of change, its adoption of smartphone technology has not. There are now more than one billion mobile phone subscribers in India, and cellular coverage has expanded into many rural areas.
Smartphone, smart vaccines
This presented an effective solution as to how best to manage the tracking, monitoring and distribution of vaccines in rural regions. Alongside our software solution development partner Logistimo, we worked with the UNDP team to develop a centralized supply chain management solution hosted in a cloud with a smart phone based interface which allowed for the tracking of vaccine inventories across the supply chain up to the last mile cold chains.
As a routine task, every vaccine handler enters the net utilization for each vaccine into the application at the end of every immunization day. This is then uploaded on a cloud server which can then be viewed by program managers at district, state and national level.
In addition, to help track storage temperature of vaccines, SIM-enabled digital sensors were attached to the refrigerators. The temperature data is recorded every 10 minutes and updated via GPRS over the mobile network. In case of a temperature breach, alerts are sent to the responsible managers.
Connecting with the community
In order to deliver a replicable and scalable model that could serve even the more inaccessible regions of rural India, working closely with local communities was vital. By actively engaging with the local population, they become a critical part of the network and help overcome the last-mile distribution challenge (the process of delivering people, goods or services to their final destination).
Our team developed a central organizational structure, with around 400 people deployed across 11 states, in order to train more than 14,000 people from the local community as vaccine cold chain operators. Many of them may never have seen a smartphone, but alongside the local trainers, we set up a call center to support them in using the new software.
By utilizing local expertise and enthusiasm and combining it with modern logistics technology, we helped to develop an integrated solution that has helped significantly improve vaccine delivery, procurement and planning.
"The important work that is being done here is that people are targeting not just the easy to reach but really trying to go out and find those that are not well served, the hard to reach communities," says Dr. Seth Berkley, CEO, GAVI.
The better the world works
Technology and collaboration to solve the last mile distribution challenge for vital services
Better vaccination, Better health, Better lives
Following its launch, eVIN cold chain operators and managers now log over two million vaccine transactions and 80 million temperature samples online every month. Vaccine stocks are replenished on average every two days, down from five days prior to the project.
After the success of the initial phase of the eVIN project, we helped UNDP to roll it out across another eight states. With the support of the UNDP, the Ministry of Health is now expanding the project across the entire country. And there are hopes that the work could be expanded to other countries struggling to distribute vital vaccines and preventative medicine to children.
As Dr. Berkley says, “If we can make this system work here in India, it has implications more globally, as this is a problem that most developing world countries have.”
The eVIN project is an example of how we can work closely with public sector and nongovernmental organizations to deliver tangible progress toward this goal.
It also shows how by embracing digital technology and building close relationships with local communities, to better understand their behavior, our teams can help organizations overcome the many logistical and last-mile distribution challenges that exist around the world.