To drive continuous improvement in supply chain performance a multi-disciplinary approach that focuses on people, technology, and processes is essential. JSI is helping countries establish Information Mobilized for Performance Analysis and Continuous Transformation (IMPACT) Teams – groups of people harmoniously working together – to analyze performance and make systematic efforts to improve the quality and efficiency of the supply chain.
In Kenya, we helped establish quality improvement teams that were set up to meet monthly, follow a structured approach to using data and taking action, and adopt a multi-disciplinary approach to problem-solving. In the initial 10 counties, the IMPACT Teams focused on family planning (FP) and immunization supply chain improvements and included members from different levels led by a county EPI logistician (CEPIL), county records and information officer (CHRIO), county reproductive health coordinator, and the county pharmacist.
The collective goal set across the 10 counties was to improve data availability, quality, and use to increase the availability of contraceptives and vaccines at health facilities. Every month, these teams review data extracted from DHIS2 into an Excel-based indicator tracking tool (ITT) that visualizes the data on a dashboard for easier analysis and interpretation, prioritize the problem to focus on based on their overall performance targets, conduct a root cause analysis for problems preventing achievement of desired performance and brainstorm possible solutions and actions. The multi-disciplinary nature of the team is a core component and critical in determining the root cause and identifying holistic, creative, local solutions, and actions to be taken. As an example from one county, Nandi, this approach enabled them to conduct a redistribution exercise after their data revealed overstocks of some FP commodities at some sub-counties while others did not have stock. This is one example of a simple solution Nandi implemented through the IMPACT Team approach – using their data to make decisions and take action to improve their stock availability.
IMPACT Teams have since been scaled up to support other programs where the importance of a multi-disciplinary approach has become even more evident. In September 2017, inSupply organized IMPACT Team trainings on using vaccine and remote temperature monitoring (RTM) data for decision making and action in Nairobi, Kajiado, and Isiolo counties. Ninety-five participants, consisting of sub-county medical engineering technicians (METs), sub-county public health nurses, sub-county EPI logisticians, facility in charge, and sub-county store managers, participated.
inSupply installed 36 ColdTrace5 devices at high volume facilities and sub-county vaccine stores to assist in monitoring the temperatures of their cold chain equipment (CCE) in real time. The device emits alarms and sends message alerts through an RTM dashboard when there is a heat event (above 8°C for more than 10 hours) or a freeze event (below -0.5°C for more than an hour). During the first IMPACT Team meeting, the multi-disciplinary team discussed and identified the indicators for monitoring vaccines such as reporting rate, vaccine coverage, vaccine stock status, and vaccine wastage rates. Teams also reviewed their cold chain data for the month of August, discussing temperature excursions, percentage equipment uptime, and cold chain maintenance and repair procedures.
The teams largely focused on data accuracy for vaccines and identified data quality as a critical action point. The county teams committed to improving the data quality as the first action to monitoring the rest of the indicators.
The IMPACT Team approach is designed to use data to question what is going well and correct what is going wrong. The multi-disciplinary teams are established to work together to identify the best local solutions and actions that when executed regularly, lead to continuous improvements in the supply chain and cold chain systems.
*During the meeting, it became clear that METs were not exposed to vaccine data, but they knew exactly what was happening with the cold chain equipment. Additionally, the nurses were very knowledgeable in the handling of the vaccines, but many mentioned they had not received specific training on the CCE. The team setting illustrated the clear value in having the nurses and METs in the same room as they were able to see the connection between malfunctioning of the CCE and the effect on coverage rates, closed vial wastage, and stock status. As an addition to these two groups, the CHRIOs could defend the data and provide explanations where there were gaps.