Immunization Nurse

Otherwise known as: Immunization Health Worker, HW Technician, HF Supervisor

Goals

I want to avoid and minimize stock outs.
I want to avoid and minimize vaccine wastage due to CCE failure.
To manage my CCE's vaccine stock levels.
I want my facility to have the right stock at the right time. I want to ensure the right stock is being ordered and/or delivered
Be present during a vaccine direct delivery visit
Uphold FEFO by ensuring correct stocking of vaccines inside the CCE
I want to make sure I have all the requisites to use each antigen (e.g. diluent, injection device, sharps box, etc.)

Roles

Pull-Systems Requisition role:

Complete & submit monthly requisition form

Push-Systems Allocation role:

Report routine data (on which allocation is based)
Compare delivery receipt to actual order delivered and if acceptable, sign. When not acceptable, provide reasons

Stock Management role:

Records stock movements, receipts, adjustments
Views & monitors Stock on Hand (SOH)
Vaccine and requisites stock present within the SDP’s CCE (usually 1:1 ratio of CCE to SDP)
Uphold FEFO by ensuring correct organization of vaccines
Receive verified quantity and review quality of vaccines and determine need for remedial action when necessary
Manage POD to verify delivered quantities
Receives and responds to low stock and stock out alerts

CCE Performance:

Log functional and temperature status
Perform preventative maintenance of CCE

Data role:

Maintain paper stock card of what's in the CCE
Maintain consumption record of how many children were vaccinated via tally
Maintain CCE functioning log

LEVEL

Level 1 – Service Delivery Point

This could be a hospital out-patient clinic, a multiple-room primary health clinic, or a one-room health post in the most rural areas that does a little bit of everything but has limited resources

Key Pain Points

Stock out, over stocks
CCE failure affecting vaccine storage and having to thus play CCE troubleshooter role but not being a cold chain technician!
Not knowing when a delivery will be made to plan for immunizations and stock needed
Not knowing when a district depot will have stock in order to go pick up for facility's needs
Having to leave facility and pay for transport to collect stock from district depot.
Plays multiple roles
Time spent on reporting/data entry
Managing multiple programs' reporting needs
Not having adequate stocks of requisites

Context, Characteristics, Comments

Tech aptitude: Low technical skills
Has no / poor internet connectivity
Examples, could be nurse's assistant/nurse technician or immunization nurse
Some training in logistics management
COULD potentially use a offline tablet
Important to consider the value of a commodity/program agnostic stock management solution at this level given the amount of reporting required across programs.

District Immunization & Vaccine Officer (DIVO)

Otherwise Known As: AKA District EPI Supervisor/Officer

Goals

For my vaccines store and the facilities I supervise, I want all stores to have the right stock at the right time. I want to ensure the right stock is being ordered. I want to minimize closed vial wastage, stock outs or overstocks
Request vaccines and supplies by Sending requisition (pull) or report (push) to Regional/Provincial Vaccine Store
Receive vaccines and any other related supplies; in some instances, might have to go pick up vaccines themselves as well
Issue vaccines and supplies to Health facilities (pickup system) or
Distribute vaccines and supplies to Health facilities (delivery system)
Manage Cold Chain Equipment at District vaccine store (DVS) and Health facilities within their districts and ensures routine maintenance/service to prevent/address failure
Conduct Physical count and do stock adjustment (if needed)
Supervise all immunization related activities being done at the facilities – both in terms of vaccine handling (keeping vaccine vials in right temperature, mixing diluents with vaccines as needed etc.) and vaccine usage (immunizing people)
Uphold FEFO

Roles

Stock Management role

Monitors vaccines store stock levels and ensures physical stocks match stock records
Organizes by FEFO
Segregates expired or damaged stocks

Issuing (or Order Fulfillment) role:

Receives requisitions or reports from facility
Approves requisitions or calculates allocation
Picks and packs consignments
Prepares proof of delivery (POD) and manages or makes deliveries to the SDP (delivery system) or transfers stock to their agent (pickup system)

Receiving role:

Aggregates multiple facility requests to submit requisitions to level above (regional/provincial/zonal store)
Based on above, receives consignment from level above, compares to requisition, signs POD and notes any exceptions with reason

This process works whether it's a pickup or a delivery system, since receiving can happen either at user's own depot or at the higher-level depot

CCE & Data Management role:

Maintain stock card of what's in the CCE at district depot
Maintain CCE functioning & temperature log
Aggregate paper-based requests submitted by facilities for vaccine orders to level above
Use SMT and DVD-MT in absence of other electronic tools

LEVEL

Level 2 - Intermediate

Key Pain Points

Late receipt of requisition requests and other crucial data forms from HF
Late receipt of stock from level above that makes managing and supply stock to HF problematicLate receipt of requisition requests and other crucial data forms from HF
Lack of visibility into stock levels of HF day to day; Lack of consistent awareness regarding when facilities require replenishment
Lack of visibility into CCE performance of HF day to day
Failure of CCE in HF needing me to troubleshoot which other HF has CCE space to store the stock for the HF that has no functioning CCE anymore; troubleshoot where to route the people seeking immunizations for that HF that no longer has working CCE; troubleshoot how many immunizations

Context, Characteristics, Comments

Significant variation in terms of computer literacy and comfort using electronic tools

Cold Chain Technician

Goals

I want to be informed of failing CCE that fall under my purview so that I can schedule their repairs
I want the country to procure spare parts based on data analysis about CCE failure so that I’m like to have the spare parts I need when I have to repair CCE in the future.
I want to know common causes of CCE failure so I can make more accurate predictions/preparations about the types of repairs I’ll have to make

Role

View CCE functionality statuses to inform his/her maintenance and repair schedule

LEVEL

Level 3 or Level 2 -- Central/National OR Intermediate (in large countries) OR possibly an outsourced vender

Key Pain Points

Not enough information on what's causing CCE failure
Outdated CCE catalog so not sure which type and make of CCE is actually at the HF and when it was installed, how old it is, when it was last maintained, etc.
Inadequate resources to carry out my work: limited funding for transport, not having access to the right spare parts
Lack of access into system (lacking computer) means that I can’t see problems as they are logged but instead must wait for my manager (RIVO type role) or HF staff to tell me when there's a problem. Then I have to travel to HF once funds are provided to make the trip.

Context, Characteristics, Comments

• Might have internet connectivity
• Low information technology skills

Intermediate Level Vaccine Warehouse Manager

Goals

Visibility (into stock levels, orders) into my own facility and those I'm responsible for supplying
Ensure timely ordering/issuing of the right commodities in the right quantity.
I want my store, my districts, and their facilities to have the right stock at the right time. I want to ensure the right stock is being ordered. I want to minimize stock outs or overstocks
Receive verified quantity and quality of goods into store and determine need for remedial action when necessary.
Uphold FEFO
Manage the budget of my warehouse/store
Ensure my CCE is serviced periodically to prevent failure

Roles

Stock Management role

Manages Vaccine Stock present within the warehouse's CCE (several CCE or cold room(s) depending on how large the country's population is)
Records stock movements: stock issues, receipts, adjustments
Views and monitors stock on hand at their own warehouse and lower levels
Ensures all transaction (eStock Card) data are accurate and up-to-date
Receives stock issued by national warehouses
Manage POD to verify stock shipped quantities

Issuing (Order Fulfillment) role:

Creates and edits and authorizes requisitions
Fulfills orders from levels below; places orders for more stock from national level
May do local fulfillment (to facilities and users within OpenLMIS)
May do fulfillment (fulfill many requisitions with one delivery)
Manages Vaccine Stock present within the warehouse's CCE (several CCE or cold room(s) depending on how large the country's population is)

CCE Performance role:

Monitors CCE performance

LEVEL

Level 3 OR Level 2 (in large countries)

Various levels – starting with national, regional, provincial, zonal, and even districts in large countries – essentially someone who has to manage multiple vaccine CCE or cold rooms and the stock stored in them.

Key Pain Points

Stock out, over stocks
Poor visibility into lower level inventories and therefore unable to be proactive
Plays multiple roles
Does not receive requisitions and necessary approvals in time

Context, Characteristics, Comments

Has internet connectivity
Med. - low technical skills
Would like to see stock levels of lower facilities to decide how much to issue going forward instead of relying on static number to give each month
Would like an easy to use and intuitive system
Would like to use barcode scanners to reduce data entry burden

Intermediate Level Logistician

Otherwise known as: Intermediate Level Distributor/Field Coordinator

Goals

Visibility (into stock levels, orders) into my own facility and those I'm responsible for supplying
I want my districts and their facilities to have the right stock at the right time. I want to ensure the right stock is being ordered. I want to minimize stock outs or overstocks

Roles

Resupply Role (delivery system)

Works with warehouse manager to bundle orders to be delivered to lower levels and helps warehouse manager decide how much for each facility
May do local fulfillment (to facilities and users within OpenLMIS)
Audits physical stock count for each facility that s/he is delivering to

Data Management role:

In Informed Push SC systems (delivery system with push/allocation) like in Mozambique and Benin, this role is the one that digitizes facility level data regarding stock movements and CCE functioning, because they have access to this data when visiting facilities with scheduled distributions. They either make paper copies of facility level data to bring back to their level and digitize using computers at that level, or they are provided with tablets that they can use for direct data entry from the facility by referencing the paper forms available there.

Stock Management

Manage Vaccine Stock present within the warehouse's CCE (several CCE or even a cold room depending on how large the country's population is)
Views and monitors stock on hand at their CCE and lower levels
Manage monthly requests from levels below and places quarterly orders for more stock from national level
Records stock movements: stock issues, receipts, adjustments Views and monitors stock on hand at their CCE and lower levels
Receives notifications for low stock/stock outs at lower level facilities and depots

CCE Performance role:

Reviews CCE performance and acts as first solution for fixing issues with CCE (has some preventative maintenance training) before calling on CCE technician to fix larger problems

LEVEL

Level 3 OR Level 2 (in large countries)

Various levels – starting with national, regional, provincial, zonal, and even districts in large countries – essentially someone who has to manage multiple vaccine CCE or cold rooms and the stock stored in them.

Key Pain Points

Stock out, over stocks
Plays multiple roles
Does not receive requisitions and necessary approvals in time

Context, Characteristics, Comments

Has internet connectivity
Medium to low technical skills
Would like to see stock levels of lower facilities to decide how much to issue going forward instead of relying on static number to give each month
Would like an easy to use and intuitive system
Would like to use barcode scanners to reduce data entry burden

EPI Program Supervisor

Otherwise known as: EPI Program Manager (Central level), Regional Immunization and Vaccine Officer (RIVO), Provincial EPI Chief (Regional

Goals

To have the right amounts of potent stock available for the needs of the service delivery point and district depots
Review the requested quantities to ensure the appropriate amount of stock is being requested/ordered.
Review Budgets
Be able to communicate needs of clinics/districts under his/her purview to people in level above to inform overall EPI strategies
To ensure CCE within my administrative area remain functional; maximize CCE uptime.

Roles

(Does not handle vaccines or manage vaccine store)

Approval role:

Approve requisitions (pull) or allocations (push) in order for depot to fulfill orders
Logs in to approve/reject/edit requisitions made by DIVO or DIVO-type role at their level
Reviews and monitors stock movements and stock on hand at service delivery points
Receives and responds to notifications for low stock/stock outs at lower level facilities.
Usually becomes aware of problems with stock or CCE because DIVO/district EPI supervisor persona is informing and not because s/he logged in and reviewed the data

LEVEL

Varies -- Central/National, Regional, District

Key Pain Points

Late reporting (requisitions submitted) from SDPs
Late reporting (stock issues/adjustments/etc. on a monthly basis) from SDPs
Stock out, over stock
Failing CCE

Context, Characteristics, Comments

Has tech aptitude: varies
Likely a medical professional (MD or Pharm.) with limited to no logistics knowledge
Not a primary user of nor familiar with OpenLMIS
Only uses OpenLMIS to approve/reject requisitions

National Vaccine Warehouse Manager

Goals

Manages the orders for the national vaccine warehouse
Works primarily in the national ERP
Maintain chain of custody and appropriate environmental conditions for stock and inventory.

Roles

Order Fulfillment Role:

Convert approved requisitions to order
Views orders

LEVEL

Level 3 OR Level 2 (in large countries)

Various levels – starting with national, regional, provincial, zonal, and even districts in large countries – essentially someone who has to manage multiple vaccine CCE or cold rooms and the stock stored in them.

Key Pain Points

Responsible for a lot of paperwork
Doesn't want to log into another system

Context, Characteristics, Comments

Well educated
Sits at the central/national warehouse

Central Logistics Personnel

Goals

Approve or reject R&Rs for all districts / regions / provinces that report to her
Reach 100% reporting rate
Increase data quality of reporting districts/regions/provinces (to decrease her workload)
Keep higher-ups updated with aggregated reports

Roles

Requisitions role:

View requisitions
Approve submitted requisitions

Stock Management role:

Decision maker -- Initiates stock recalls

Data role:

Create monthly/quarterly reports for higher-ups
View reports
View reporting rate of districts/facilities/lower levels
Decision maker -- Uses stock estimated and usage data from system for long term supply and program planning

LEVEL

Central Level

Key Pain Points

Stock out, over stock, wastage
Failing CCE
Struggling with forecasting the right amount

Context, Characteristics, Comments

??

System Administrator

Goals

Assist users in their use of the system
Makes sure the system is up and running
Maintains the system (backups, performance, data)

Roles

Responsible for ongoing administration of the system.
Add users, products, facilities, etc. as the system evolves

LEVEL

Central Level

Key Pain Points

Lack of intuitive navigation
Lack of robust configuration
Lack of global permissions

Context, Characteristics, Comments

Has Information technology skill set for system administration
Must have all data needed for configuration of the system
Has internet connectivity
Most likely a national of the host country with a local degree in information systems

Intermediary Data Manager

Otherwise known as: District Data Manager

Goals

This is a Support role when needed in the iSC world

Roles

Pull-Systems Requisitions role:

Receives Requisitions from facility;
Aggregates multiple facility requests to submit requisitions to level above (regional/provincial store)

In some places, due to capacity/staff time available, district data manager will assist DIVO persona by doing the aggregation and digitizing of HF paper requisitions into an online system. But does not have a formal/ traditional role to play in the logistics/supply chain.

Pull-Systems Requisitions role:

Aggregate monthly service delivery data received from HFs via paper and either put information in a paper form or digitize online via an HMIS (such as DHIS-2) – service delivery data could be info like # of kids immunized for each vaccine type in that month, # of malaria cases, # of confirmed TB cases, etc.
For iSC: when needed, aggregates paper-based requests submitted by facilities for vaccine orders to level above;
Use SMT and DVD-MT in absence of other electronic tools

LEVEL

Level 2 – Intermediate/District

Key Pain Points

Time spent on reporting/data entry
Managing multiple programs' reporting needs

Context, Characteristics, Comments

Has internet connectivity
Med-low tech skills