mardi 25 juillet 2017
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How vertical is the immunization service delivery and supply chain information managment system when they are migrated into electronic paltform? Should it be part of routine HMIS or LMIS system? or a separate one?

il y a environ 6 ans
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#4714

This is a great question, and the answer is, as always, it depends.

I suggest you read a recent publication I co-authored called Critical Success Factors for Deploying Digital LMIS, which addresses the LMIS aspects of this question. I know some countries (like Tanzania) have opted to integrate service delivery (HMIS) and supply chain (LMIS) into a single information platform called the Vaccine Information Management System (VIMS). However, VIMS was built as a module with the integrated eLMIS for all products using the OpenLMIS platform, which has been extended to support all immunization program data. Others, such as Ethiopia, have integrated vaccine supply chain information data into an integrated LMIS, while letting the HMIS technology solutions provide for other EPI program data requirements.

My personal suggestion is that supply chains should be supported with software solutions that are specifically designed to support the workflows and business processes of a supply chain; see  Information Systems for Supply Chain Management: The case for connecting separate and interoperable technology applications for Logistics Management Information System and Health Information Management Systems dataInformation Systems for Supply Chain Management: The case for connecting separate and interoperable technology applications for Logistics Management Information System and Health Information Management Systems data.

il y a environ 6 ans
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#4715

I have seen many different approaches. It really depends on the country, how EPI is organized and who has the responsibility to monitor service delivery and the supply chain. In some countries, the EPI is reposnible for both, in others the EPI for one or the other, or none; in some countries the supply chain is monitored by a LMIS that includes not only vaccines but other medications, in others not; same with HMIS, in some countries this is the only system to monitor doses administered, while in other countries there are parallel systems EPI and HMIS. 

The most important aspect, I would say, is to ensure that whatever electronic info system is used meets all the needs (managerial and for monitoring) and functional standards requiered by all persons involved, at different levels. In a few countries (that I have seen), they have managed to integrate both systems and make them inteact with each other. For example, in teh city of Bogota, there is an electronic registry that crosses info with the supplies used and wastage. 

I would recommend reading the Optimize Manual on the topic: "Planning an Information Systems Project: A Toolkit for Public Health Managers". This toolkit can help public health managers plan for the implementation of information and communications technology in health information systems. It draws on lessons learned by project Optimize, a five-year collaboration between the World Health Organization and PATH, to help optimize the vaccine supply chain. Author(s): Grevendonk J, Taliesin B, Brigden D. Corporate author(s): PATH, World Health Organization. Publication date: July 2013. Available at:  https://www.path.org/publications/detail.php?i=2343 

il y a environ 6 ans
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#4716

An interesting question. In the US, Immunization Immunization Systems (IIS) are state-run systems not a single, large Federal system for the whole country. Some large municipalities (like NYC) and US territories (like Puerto Rico) have their own as well.

By and large, IIS are single-purpose public health registries that serve only immunization program needs. But there are some exceptions. Is the State of Rhoad Island, for instance, we support a comprehensive child health system called KIDSNET (http://www.health.ri.gov/programs/kidsnet/index.php) which covers many child health programs and integrates the data together for both the clinical community and public health surveillance. In NYC we created a Master Person Index to help the IIS (called the Citywide Immunization Registry, or CIR) and Lead Poisoning Prevention information system (called LeadQuest) interoperate and exchange data without becoming fully integrated since they are controlled by different parts of the agency. Other examples exist as well.

il y a environ 6 ans
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#4724

As other have said it depends.....and the main thing it depends on is how integrated your supply chain is? and what are the existing process links between LMIS (Supply chain) and HMIS (service)

I can speak to a specific country example Ethiopia but simply as an example, that is context specific not as neccessarily a best practice

In Ethiopia the EPI supply chain used to be pretty much vertical, following the MOH bureacratic levels. For other essential medicines you had a professional Federal agency of the MOH (PFSA)

The MOH decided to have PFSA also manage EPI about five years ago, and its been a slow process towards "integration" (I use inverted commas for a reason as integration is sometimes thought ot mean a one size fits all but in reality for each SC process there will be a continuum between 100% vertical and 100% integrated)

One of the reasons in Ethiopia towards integration was that PFSA had a functional electronic LMIS (the HCMIS system) while for EPI there was only paper, and that didnt work very well (so no data/slow data/poor quality data). So the e LMIS in Ethiopia was the very first proceess to integrate and now EPI data - centrqal/regional and district; facility data is still on paper) can be visualized on a Dashboard (close to real time data). You can pull up data for any mediicine in an integrated dashboard, with a custimized page for EPI.

I'm not sure stakeholders were willing to invest in a brand new LMIS specifically for EPI, aned since PFSA were the owners of the EPI SC they were eager to use their exisitng eLMIS (HCMIS) to maximize effeciency and sustainability. newly developed mobile systems (at district level) are also fully interoperable with the HCMIS system (used at central and regional levels) so disrict level data can also be accessed on the dashboard

 

As yet, HMIS data for EPI is not part of the SC dashboard, that is the next challenge (among many). While the paper EPI SC forms include some service data reporting is poor (no data, and/or poor quality data). An electronic system wont change that per se - what it will do is it will make sure good data from a paper system once captured is replicated quickly and accuratley. It wont fix bad data from lower levels. 

So, currently in Ethiopia for the eLMIS to capture service data for EPI is not a technoogy problem its a business process problem 

 

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