Paraguay’s evaluation of the VSSM

Many thanks to Mojtaba Haghgou for suggesting that this summary be posted here. Cross-posted from the PAHO Immunization Newsletter, December 2011. In January 2010, the Pan American Health Organization (PAHO) began piloting a software to manage and control vaccines, syringes and other supply inventories (Vaccine Supplies Stock Management - VSSM)1 in Member States’ National Immunization Programs. The VSSM was developed by the World Health Organization (WHO) and is based on a Microsoft Access platform. It can be implemented at any level, from local to national. The introduction of new vaccines in recent years, many of which can be expensive, justifies the implementation of effective and easy to use tools for stock management. Bolivia, Honduras, Nicaragua, Paraguay, and Venezuela were selected to carry out pilot programs using this software. During 2010, four workshops were held to train vaccine warehouse management and cold chain management personnel, as well as the Expanded Program on Immunization (EPI) managers on how to use this new software. Paraguay was selected to evaluate and document the VSSM’s usefulness and effectiveness. Paraguay’s population consists of 6,451,122 inhabitants. It is divided into 18 departments and 236 municipalities. The EPI has a national vaccine warehouse located in the capital, Asunción. Five regional vaccine warehouses are located in the following health regions: Caaguazú, Concepción, Misiones, Alto Paraná, and San Pedro. Paraguay implemented the VSSM at the national vaccine warehouse in May of 2010. Subsequently, the implementation was expanded to the five regional warehouses in July 2010. In January 2011, the training on the installation and use of the VSSM to information technology personnel was expanded to the other 14 health regions. Objectives of the evaluation: • Evaluate and document: ? The usefulness, applicability, efficiency and operability of the VSSM Software for: Decision-making on the logistics for receipt, storage and distribution of vaccines and supplies used by the EPI. Improvement in the operations related to the management of immunobiologicals and supplies in warehouses. ? Experiences and difficulties in the management of the VSSM: Data entry Use of the reports ? User-friendliness of the VSSM ? Improving the use of the VSSM ? Suggestions and recommendations ? Suggestion for improved training Methods: • PAHO’s Comprehensive Family Immunization Project, in the Area of Family and Community Health (FCH/IM), developed an instrument/guide to be used in the evaluation of the VSSM’s management, usefulness and effectiveness. This instrument consists of two types of questions: open-ended and “yes”/”no”. • Observation and interview visits were conducted and the instrument was applied to EPI authorities and VSSM users at the National Center of ePI Vaccines as well as in four regional vaccine warehouses: Alto Paraná, Caaguazú, Concepción, and San Pedro. Main findings: • Management of VSSM ? Interviewed personnel demonstrated both knowledge and use of VSSM. ? Interviewed personnel stated that the VSSM is reliable and user-friendly. ? A crossed-referenced control between the physical vaccine supplies available and the “in existence” report generated by the VSSM was carried out in each vaccine warehouse. This is done in order to confirm that the amount of vaccines in existence in the cold storage rooms were represented by the quantity provided in the VSSM. It is worth noting that the physical count coincided with the VSSM report in all cases. ? The invoicing system has been used to identify lot number, expiration date, supplier, and the location in the warehouse of vaccines, syringes and other supplies to be distributed. ? Seven reports are primarily used: receipt of supplies, dispatches, current existence, storage space available, supplies by client, current stock and invoices. ? The EPI manager receives the following reports monthly: receipt of supplies, dispatches, and current stock. ? The following reports are sent quarterly to the Department of Financing: receipt of supplies and deliveries. ? VSSM triggers the following alerts: expiration date: 6 months/< less than. Maximum and minimum stock in existence: 3 months ? Each of the five regions sends the “data file” to the chief of the national vaccine warehouse monthly. • Report usefulness ? Interviewed personnel stated that the VSSM generates reports that contain the required information immediately, reliably, and in a way that facilitates inventory management processes. ? System operators at all levels reported that the use of the VSSM had a positive impact on their daily work, in addition to the usefulness of the reports generated by the VSSM. These reports meet the needs within the management processes for the administration of vaccines and supplies. ? Reports generated by the VSSM on “warehouse use” provide useful and accurate information on the current storage capacity available in the refrigerated and air-conditioned environments (diluents, syringes, safety boxes and general supplies). ? The VSSM generates a report facilitate the immediate location of vaccines and supplies by class, lot, expiration date, supplier. Interviewed personnel indicated that this information is of great value. • Warehouse management: what processes changed after the installation of the VSSM? ? Before the implementation of the VSSM, a traditional inventory management system using excel tables and paper files was used. Although well organized, this approach was time consuming and challenging for obtaining reliable data. The implementation of the VSSM has made it possible to integrate these multiple manual processes into a single database and reduce errors. ? With the introduction of the VSSM, the processes and information of the inventory management and control were facilitated. ? The VSSM has provided the necessary alerts for preventing shortages and over-stocking vaccines and supplies. It has also generated alerts on the expiration dates, which have been useful in minimizing vaccine wastage. • General observations ? In general, the VSSM was regarded as a very useful and efficient tool at the national level. The EPI manager based the decision to expand the VSSM to the five regional vaccine warehouses and subsequently, to the remaining 14 health regions. • Training and supervision ? A training program was developed and implemented by the chief of the national vaccine warehouse and the EPI information system specialist. They had been previously trained in a workshop carried out by PAHO and the Bolivian Ministry of Health. The training program was implemented in two phases under the coordination of the EPI manager. ? Five staff members responsible for the regional warehouses were trained in July 2010. Personnel responsible for the information systems in the 14 remaining health regions were trained in January 2011. ? A supervisory visit was carried out after the implementation of the VSSM in the five regional warehouses Main conclusions: • The implementation of the VSSM has resulted in improvements of the management inventory processes related to the handling of vaccines and other supplies used by the immunization program. • The VSSM is a useful, effective and reliable tool that integrates all management information from inventory management processes into a single database. • Staff is knowledgeable on the use of the VSSM and how to generate and access reports on receipts and dispatches of vaccine and other supplies. • The introduction of the VSSM supports better management and planning of inventories.