Using software to achieve continuous quality improvement

Written by: S Kibet, WHO Kenya; P Zaninka & T Rweizire, Uganda EPI; R Anderson, UW; and S Newland, PATH Improving the efficiency and effectiveness of vaccine supply chains is no easy task, especially when data is difficult to gather, financing is tight, and there is pressure to improve and expand. Supply chains, by nature, are made up of multitudes of constantly-shifting variables, and few Expanded Programme on Immunization programs have the right tools to track and maintain those variables in a systematic way. Recognizing the urgent need for countries to inventory and better manage supply chain equipment such as refrigerators, cold rooms, and cold boxes, PATH developed a Microsoft Access-based software tool called Cold Chain Equipment Manager (CCEM). The tool can help vaccination programs manage equipment requirements down to the facility level, forecast equipment needs for different scenarios, and generate procurement lists according to national policies. CCEM differs from other available equipment management tools because, in addition to the usual data management, analysis, and reporting functions of a conventional inventory, it allows countries to view the cost and logistical implications of potential programmatic changes through “what if” scenarios such as procedural changes or the introduction of a new vaccine. These additional benefits were convincing enough for Kenya to conduct a pilot of the CCEM tool this year. Over the next several months Kenyan health staff will complete district-level questionnaires which will generate data on the existing cold chain equipment in Kenya and its functional status. CCEM will help decision-makers answer some challenging questions: What are the capital and operational costs of introducing pneumococcal vaccine? What would be the cost of changing vaccine presentation from 20-dose vials to single-dose vials? How should the vaccines be distributed? With this data, health staff can use CCEM to generate a cold chain expansion and replacement plan with annual estimated costs associated with introducing newer and bulkier vaccines. When Uganda piloted CCEM in 2007, public health managers found they could introduce human papillomavirus vaccine without buying new refrigerators. They also saw that the primary storage issues were going to be at the national and provincial levels and transitioned resources to those levels to accommodate the increased burden. Since then, the CCEM tool has been a useful reference bank for information about cold chain inventory and status as it can quickly calculate storage capacities, shortages, and surpluses. This has proven useful as Uganda prepares for the introduction of pneumococcal vaccine. Not only does CCEM calculate equipment needs over time, it also calculates the annual costs of upgrades and determines the long-term costs of various equipment choices. The challenges to the CCEM tool center on data entry which requires some training and knowledge of the equipment specifications and local geography. Improper data reporting by field staff can also result in inaccurate equipment requisitions and placements. The tool itself is difficult to transfer electronically because files are so large and so intricately linked to data. Despite these challenges, health system managers in Uganda have found it to be a very useful tool. The upgraded CCEM version 2 is up to date with 61 pieces of PQS (performance, quality, safety) prequalified equipment from the World Health Organization (WHO). PATH will continue to keep the equipment list updated as long as funding allows at which point WHO might provide updated lists that can be easily imported into the CCEM database. CCEM can be implemented at subnational, regional, and/or district levels and requires an upfront investment of time and resources to gather and input data. It also requires ongoing use to keep the data relevant. CCEM is a timely, free resource that any country can use to inventory and then improve management of supply chain equipment. To inquire about CCEM, send an email to [[email protected]][email protected][/email] to receive a free copy of the software. Questions about how to use and implement the software should be directed to [[email protected]][email protected][/email]. We invite you to comment on or post a question relating to the new website by clicking the “reply” button on this page. You will have to log in or register; the process is very simple. Return to the Optimize newsletter.