In Sindh Province, as in the rest of Pakistan, logistics data for the immunization supply chain was sporadically collected and seldom used for years. Stockouts of critical vaccines were commonplace, resulting in poor coverage rates and frequent outbreaks of measles and other vaccine-preventable diseases. In 2013–2014, the federal and provincial governments, supported by JSI (under the USAID | DELIVER PROJECT), USAID, UNICEF, and WHO, developed and launched a web-based vaccine logistics management information system (vLMIS) to address this problem, and started an ongoing effort to scale up use of the system across the nation. Sindh has since fully deployed the vLMIS in all districts. But deploying the system has only been one aspect of the work to improve data visibility and use.
In the first of a series of stories on logistics data visibility and use in Pakistan, we read about the impact of computer technology on supply chain workers and their performance.
Use of computers and the internet as communication means is now commonplace around the world, yet in Benazirabad District, Sindh, most of the vaccinators, Taluka (subdistrict) Superintendents/Vaccination (TSV), and District Superintendents/Vaccination (DSV) of the Provincial Health Department belong to a generation that is not familiar or comfortable with the use of these technologies. The main reason is low computer literacy and a lack of experience and institutional capacity building in technology use. This has been a significant challenge in the deployment of the advanced web-based vLMIS. It has hindered the appreciation and use of the system, and consequently affected the reporting and analysis needed to ensure effective service delivery.
But seeing and using is believing. Smiling eyes spoke of the joy and pleasure that Rana Abdul Sattar, the statistical assistant and district EPI store incharge, had the first time he created and printed a vaccine voucher, and issued vaccines to the subdistrict store on a computer using the vLMIS.
For the two years following the 2014 launch of the vLMIS, Sattar manually recorded vaccines issued to Taluka stores, writing all the details by hand and then giving the vouchers to other staff for entry into the vLMIS. He didn’t attempt to use the system, as no one trained and encouraged him to do so. But with support from a new project focused on data visibility and data use at every level of the immunization supply chain in Pakistan, things are starting to change.
A local quality improvement team (QIT) was established in the district’s health department to use the data provided by vLMIS to make operational decisions and to improve performance of the supply chain. A JSI consultant embedded with the team provides hands on vLMIS training and encourages the health department vaccination staff to use it themselves instead of relying on data entry clerks.
Sattar tells his story in his own words: “I was very happy when everyone appreciated my work in the first QIT meeting. All this was possible because of the encouragement I received from the team. The vLMIS training enabled me to receive vouchers from the divisional store and in turn issue vaccines to subdistrict stores electronically. I can also generate vaccine requests using vLMIS and monitor stock availability and consumption by myself. This helps me plan, manage and issue vaccines to EPI centers in a transparent manner. By switching over to modern communication gadgetry, I can do things efficiently, saving my time for other tasks at hand. I have no worries about stock record keeping now as these are updated instantly through the vLMIS, for which I am thankful to the QIT and JSI.”