CommCare Informed Push Model System

An innovative distribution system addressing supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators

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Contact

Codou Ndiaye Email
Senior Project Manager
Ismaila Diene Email
Country Programs Director
Dimagi

Implementation Partners

Government of Senegal: Ministère de la Santé et de l’Action Sociale (MSAS) - Ministry of Health / Pharmacie Nationale d’Approvisionnement (PNA) - National Supply Pharmacy
IntraHealth International
Dimagi

Funders

Merck for Mothers
Bill & Melinda Gates Foundation

Geographic Scope

1,466 facilities and 1,627 health workers in all 14 regions of Senegal

Implementation Dates

2013: Intrahealth and Dimagi implemented the Informed Push Model (IPM) project with the MSAS and PNA to expand access to 40 family planning products.
2017: IPM system deployed on a large scale,ie accepted at the national level by the MSAS and the PNA and extended to 118 essential drugs.
2018: Dimagi began transferring the program and technology to the PNA for national ownership

Target Users

Health Care Provider, Health System Manager, Data Services Provider

Enabling Environment Building Blocks

Leadership and Governance, Strategy and Investment, Legislation, Policy, and Compliance, Services and Applications, Standards and Interoperability, Infrastructure, Workforce, Integration and Sustainability

Introduction

Senegal’s government has pledged to reduce contraceptive stockouts, which have been frequent for years in public health facilities. Lack of quality/reliable data and insufficient utilization of data are major health system challenges that led to the introduction of an innovative distribution system called the Informed Push Model (IPM) or Yeksi-Naa (“I arrived” in the Wolof language) system, addressing supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators. The Yeksi-Naa system informs a push model of supply chain management in targeted health facilities.

In 2013, IntraHealth International, in collaboration with the Ministry of Health (Ministry), National Supply Pharmacy (PNA), and Dimagi, started expanding access to—and use of—family planning by reducing contraceptive stockouts by implementing the IPM. The model made available a wide range of family planning commodities—initially around 40— allowing women to freely choose the methods they want at affordable prices.

Following promising pilot results, the Ministry of Health committed to a three-year expansion of IPM to all public health facilities nationwide, reaching nearly 1,400 facilities by the end of 2016. Today, the Yeksi-Naa system has scaled nationally to improve the family planning supply chain in Senegal’s public sector and even extended to 118 essential drugs.

Project/Digital Health Solution Overview

IntraHealth and Dimagi have worked together to develop and deploy an electronic Logistics Information Management System (eLMIS) using CommCare[1] applications for the management of all family planning commodities in 1,400 facilities across Senegal.

In this deployment, mobile logistics operators equipped with commodities travel to each facility to perform inventory management tasks, track indicators, and deliver commodities on the spot. Each logistics operator delivering supplies to points of sale on a regular schedule is equipped with a tablet running CommCare, which allows them to easily record, manage, and review stock information for hundreds of facilities, ensuring that each site and warehouse is sufficiently stocked, and allowing manufacturers to keep pace with demand, taking the burden of tracking and ordering inventory off of pharmacies and clinics.

The system is tracking real-time facility-level data and making them available through a series of costumed dashboards at the district, regional, and national levels —allowing for improved supply forecasting.

Evaluation and Results Data

Moving from paper to the eLMIS enabled stronger forecasting and tracking. Logisticians can use historical data to estimate the amount of product each clinic needs and can adjust this amount based on a number of variables, including climate conditions, fluctuations in nationwide health trends, and regional or local factors.

Over two years, IntraHealth partnered with Dimagi to support transfer of technology to the National Supply Pharmacy (PNA). This included training of trainers on the CommCare application; management of the back-end application creation platform, CommCareHQ, in which new hierarchies and location products can be added; and assisting the National Supply Pharmacy to define standard processes for deployment, troubleshooting, and data management.

After Senegal’s national digital health strategy was established, Dimagi and the National Supply Pharmacy created a local server within the National Supply Pharmacy, based on PNA-defined capabilities and infrastructure requirements, where the CommCare solution and data are hosted and managed independently by the National Supply Pharmacy. The instant transfer of data from districts and regions helps ensure that information captured from facilities aligns with that recorded at the national level and can be used to regularly report on trends and track progress toward global and national targets

CommCare Distribution Model Illustration

CommCare to support Yeksi Naa Distribution Model

  • The pilot phase of IPM increased the use of modern contraceptives by more than 90 percent in some regions, influencing the Ministry’s decision to scale the model nationally. Areas that were still experiencing stockouts attributed them mostly to unexpected spikes in consumption. Other shortages were linked to logistician errors, nonpayment from facilities, or contraceptive community outreach programs that spurred demand that was not communicated to logisticians.
  • In 2016, the unmet need for contraceptives had dropped from 88 percent to 53 percent. Nationwide consumption of contraceptives increased by 48 percent over the 14-month period from April 2015 to May 2016 after full IPM scale-up. The Ministry and the PNA expanded IPM to include other essential commodities beyond contraception, as part of a broader supply chain transformation.
  • In 2017, Yeksi-Naa was able to consistently deliver more than 100 essential health products to facilities around the country. That same year, it reduced contraceptive stockouts to an average of 2 percent of all health facilities nationwide, improving access to family planning for an estimated 3.2 million women. Consumption data from all health facilities is captured electronically and is available for procurement and programmatic decisionmaking. Margin redistribution is estimated to cover 70 percent of the costs of administering Yeksi-Naa.

Lessons Learned

  • Moving from paper to the eLMIS enabled stronger forecasting and tracking. Logisticians can use historical data to estimate the amount of product each clinic needs and can adjust this amount based on a number of variables, including climate conditions, fluctuations in nationwide health trends, and regional or local factors.
  • The performance-based contract competitive bidding process used to select third-party logistics providers helped drive cost-effectiveness and quality control. If certain conditions are not met, PNA can penalize the third-party logistics (3PL) financially or even replace it. This gives 3PLs an incentive to maintain high service levels at a competitive cost and develop innovative solutions to increase efficiencies.
  • The final step in Yeksi-Naa’s success was institutionalization to ensure that the program thrived without outside funding. While a transition road to operate the program was in place, it was important to have strong advocacy from high-level government officials at an early stage as well as their commitment to expend additional resources to maintain essential activities over the long term.
  • To catalyze high-level support, the Yeksi-Naa team deployed an intense advocacy and communication campaign (certification ceremonies; advocacy workshops in all 14 regions; and consistent, direct dialogue with the Minister of Health and other decisionmakers).

Conclusion

The Yeksi-Naa system has succeeded in transforming the supply chain system in Senegal thanks to an improved design of the system passing from traction to push, to an outsourced distribution from the public to 3PL, to better visibility data from paper to Android tablets (using CommCare), and increased financial sustainability moving from initial payments to post-consumer payments in healthcare facilities.

References

  1. CommCare developed by Dimagi is an open-source mobile platform designed for data collection, client management, decision support, and behavior change communication
  2. Expanding the Informed Push Model for Family Planning in Senegal (Yeksi Naa) (https://www.intrahealth.org/projects/expanding-the-informed-push-model-for-family-planning-in-senegal)
  3. Reproductive Health Programs (https://www.dimagi.com/sectors/reproductive-health/)
  4. Getting Contraceptives to Women Who Need Them: Senegal’s Informed Push Model (https://www.intrahealth.org/sites/ihweb/files/attachment-files/innovation-tech-briefinformed-push-model.pdf)
  5. PHCPI Trailblazer Report (https://improvingphc.org/sites/default/files/R4D_PHCPI_TrailblazerReport.pdf)