2018 OpenLMIS Advocacy Trip Report

OpenLMIS Immunization Advocacy with Gavi, Global Fund, and UNICEF

Trip Dates: 26 Mar 2018 - 28 Mar 2018

Jake Watson (Deactivated), Vidya Sampath and Mary Jo Kochendorfer (Deactivated) traveled to Geneva and Copenhagen to demo the 3.3 features to the Gavi Secretariat and UNICEF Supply Division In addition, the team had one-on-one meetings with key Gavi Senior Country Managers representing 12 countries, and the Global Fund.

Key Trip Takeaways:

The OpenLMIS standards-based approach and focus on integration does set us apart; in every interaction, this was something that needed a bit of initial explaining, but then people really caught on to the idea and its importance, particularly when we named actual systems that OpenLMIS could potentially inter-operate with if the other system is also using standards. Everyone saw that we cared about the long-term sustainability of systems and meeting a country's needs.
Gavi operates at a super macro-level which means that all countries are painted with the same brush of infrastructure availability, people capacity, supply chain needs. We know this to be untrue and it’s on us to advocate for better automated solutions even when SCMs seem to only want a faster DVDMT-Excel tool because they assume anything more will not work in LMIC settings.
We need to differentiate better when we talk about “the product” because we noticed confusion in the audience -- we use it interchangeably to talk about products in a supply chain (as in medical commodities) and about the OpenLMIS product (as in the software). One recommendation is to be consistent -- when referring to OpenLMIS, say “software supports XX features, has YY functionality” instead of “the product supports…” etc
Integrated supply chains (in terms of Essential Meds with Immunizations): Stakeholders did not want to do that too much at this time, though we explained that they can run their own program on the same instance of OpenLMIS and keep it separate, thereby realizing some economy of scale in terms of hosting, support and maintenance, updates, etc. -- this is a key point worth repeating to any/all countries that cannot or do not want to have an integrated supply chain.
There is a need for a succinct and clear of way of letting people know how they can implement OpenLMIS and how much it will cost. How do we clearly say which partners are available and willing to support a deployment? How do we clearly clarify how they move forward with that conversation?
There clearly is quite a bit of opportunity to coordinate between Gavi, UNICEF, Global Fund and USAID. We were making connections and identifying places where the donors could potentially pool funds (Myanmar or Malawi).

Table of Contents:

Gavi Demo Notes and Feedback

Date: 26 Mar 2018 at 12:00pm

Attendees: There were 30 - 40 people in the room. The team did not pass around a signup sheet. The RSVP for the event is here.

Presentation: https://docs.google.com/presentation/d/19fwjoTAKm7KchHlXvOBdK05FnQRMzGon4k_syUGCbmw/edit?usp=sharing

Summary: A full room of attendees that were engaged and asked many questions throughout the presentation. Overall seemed like participants followed the presentation. Folks were excited about the DISC indicators. There were a few questions on capturing data from paper and DVDMT. Similar to BMGF meetings, we weren’t really allowed to get past slide 3 before we the questions/bombarding began -- team had to be flexible in staying engaged and setting aside the script to go with the audience needs. Excellent post-demo follow-up conversation with the Gavi Country Performance Monitoring Unit team (Laura Craw, acting head and Carine Gachen, Sr Manager).

Detailed Notes

Implementer Toolkit is going to be very important and should include system evaluations and M&E recommendations for implementations. Participants asked multiple times if OpenLMIS has been evaluated by a third party. They meant both the system and implementations of it.
Participants would like to see costs broken down differently so they could be informed around costing models and ideas (ranges are fine). This is a consistent theme, people want to see more cost figures.
The question was raised around how you can evaluate digital transformations. BMGF indicated this is something they are very interested in.
Participants requested Pre/post implementation costs and impact
Comment made: 90% is paid by the donors so hard to see ownership and care taken around managing supply chains.
Targeted partner profile will be key for Gavi.
OpenLMIS team asked participants: How do the donors coordinate and influence or ask countries to be mindful of technology evaluation and selection?
OpenLMIS team asked participants: Have you considered approaching “graduated” countries directly to see how your ToC/approach works in setting where countries have to pay for their own supplies and likely to care more about a good LMIS?

Follow-up: As if USAID could publish the third party evaluations of eLMIS in TZ and Zambia. Completed on 13 Apr 2018 thanks to Lindabeth from USAID.

UNICEF D4M Team Meeting Notes

Date:28 Mar 2018 at 12:00pm

Attendees: Gemma (tead lead), Innocent (works with Ken Legins and SCS Center and direct advising to country govts), (new) Theresa (forecasting focus), Modeste (D4M focus), ?? who is now the ViVa PM

Presentation: https://docs.google.com/presentation/d/1qYnT-PvE_nSntcn3V129MMaD9lIwegpOZXpGpPFoC9Q/edit?usp=sharing

Summary: Presentation very well received; Gemma in particular pleased with the data analytics portions of the presentation and what was possible. In general, between the two orgs, UNICEF SD “got it” more quickly than Gavi did, and are a wee bit closer to country supply chains than the SCMs.

Follow up on coordinating around the implementer guide
Gemma noted the toolkit is really more current for them than anything else -- doing similar work and advising countries on data systems
Were interested in the standards and asked quite a few questions about GS1, e.g.

can we provide more case studies of how/when/where to use GS1?

Figure out who is on the MIS or technology team and follow up

Can we train them (IT team + Program managers) on the use of OpenLMIS? Could be best practice users and train the trainers? May want to use the OpenLMIS analytics framework itself…

Follow-up: Engage the team around the implementer toolkit. Do you they have suggestions or additional resources?

Global Fund Meeting Notes

Date: 27 Mar 2018 at 12:00pm

Attendees: Jake Watson (Deactivated), Ryan Wilcoxen, Sophie Logex (Manager, Health Product Management Hub at The Global Fund to Fight Aids, Tuberculosis and Malaria)

Summary: Quite a bit of discussion around ways to work together and continue to identify overlap in projects or pool funding for system implementations. Global Fund is supportive of GS1 standards and communicated they currently are putting clauses into all contracts that GS1 labeling must be available on all packaging. Sounds like the team is working on something similar to Gavi's Targeted Partner Profile work being lead by Chris Wright currently. Opportunity to coordinate with USAID on the product registry. A team member, Alfons, will attend the GS1 meeting in Ethiopia 08 May 2018 - 10 May 2018. A clear opportunity to establish a good communication with the team for coordinating on implementations, product roadmap and standards.

Follow-up: Obtain a list of their 25 high-impact countries and where they are engaged with diagnostics or supply chain activities. Shared OpenLMISv3 links. How can we link Gavi, USAID, DFID, TGF together?

Country Meeting Notes

Mozambique

Much of the conversation was around SELV and potential for EPI integration with CMAM. Acasus is also active in country with funding from DFID and is working on an application on tracking outreach/coverage. Will also work in DRC, in Mozambique, -> to pull more information in around outreach. This *should* feed into the monthly information review.

Ghana

Not much came from the meeting with the GAvi SCM but GHSC-TA put out an RFP for an LMIS several months ago and they have likely selected a system. Does anyone know anything further?

Myanmar

The EPI team has ambitious plans but the Gavi team is concerned if those plans are realistic. There are opportunities to connect the Gavi team with USAID PSM and their efforts. OpenLMIS team and Chris suggested that there should be discussions around pooling of funds.
Will support the HSS tool will support an EVM-results based improvement plan (HMIS, infrastructure, cold chain, eLMIS system - over 20 million)
LMIS Platform not chosen, though DHIS2 in place.
Probably an RFP to be produced - perhaps managed by UNICEF

Political considerations with USAID and DFID, so perhaps no pooled resources, so not from MOH or GOM.
Start in May/June (in contracting at the moment)
Under the lead of UNICEF as the alliance partner did some prep work;

Using DHIS2 (not with EPI really)

Has latency issues
Headcount is a issue
DHIS2 is very important so integration would be important
HMIS and EPI, attended a DHIS2 health facility workshop

Improvements on:

Immunization data in HMIS
Integration with HMIS and LMIS
Data quality and improvement plans

Gavi wants to support HMIS and LMIS integration

DRC

Summary

The discussion focused mainly on the major challenges faced in DRC. The SCMs didn’t know much about the status of evaluating an electronic LMIS. The group underscored the importance of starting small and in phases before any major decisions are made. PATH supported the EPI team in seeing VIMS in action in TZ but the Gavi folks had no further insight.
Rough Notes
Emmanuel talked about the current situation in DRC, which is one of their largest investments:
16% had functional CCE and HSS and CCEOP grants focused on improving that
In 2016 2,500 additional solar CCE
CCEOP (22 million) will bring the CCE coverage up to 80% and is in process, with UNICEF.
CCEOP v2
Coverage is currently stable and deteriorating (displaced 4 million, outbreaks, in a stabilization time)
Going to launch an RFP on the evaluation (impact on coverage) of the CCE equipment invest this year.

Supply chain background
- Acasus colleague based at the EPI (key findings that stock outs happening 25% of the time on average) and 7 times throughout the year. Only using information from the DVDMT to come up with these findings.
- Finding different situations within each province
- Over 100 million worth of vaccines
- Don’t know if DHIS2 module is used in DRC
- 516 have VSAT ($1.2 million annually)
- Will launch an eval of Gavi investment and on coverage rates
- > $100 million/year in vaccines
- Also funding transport (cars, trucks, pirogue, planes)
LMIS evaluations (EPI only):

CHAI
Global Fund
ELMIS/VIMS
CHAI did an evaluation
With support from PATH, the team from EPI DRC went to look at eLMIS/VIMS

Malawi

Gavi SCM is very excited about connecting the existing LMIS (OpenLMIS) to the EPI program, but has explicitly requested that we as a community wait to make any introductions until she is there in person.
Sarah Andersson was going to present on c-stock at the DHIS2 Symposium but fell ill. Are there any specific follow ups or information that JSI needs or would like around c-stock and OpenLMIS?
GS1 and global fund? x

Lesotho

A few inquiries have come from them to info@openlmis.org. We are encouraged to follow up with the SCM if we see this as an opportunity country.

Angola:

Summary
USAID PSM is moving forward with beginning an electronic LMIS implementation. They have engaged VillageReach to do the work. VR suggested waiting until more governance and policies were in place, however they are motivated and moving forward. The Gavi team expressed interest in waiting to see how things go with USAID.
Rough Notes
They had four questions for OpenLMIS:

What is the link with SMT?
What is the DHIS2 link?
Global Fund synergy, LMIS working group and what our role/contact with this
1. Sophie Logez (TGF)— support for Product Registry, track and trace
2. Also, HSS/System Design — VR has lusophone resources — could go along with USAID

HSS; Product Registry; keeping the supply chain separate, etc.
Integrated Supply Chain: not desired at this time, want the EPI to remain separate. We explained that this is possible on the same instance.

Integrated systems: They don’t want to do that at this time, though we explained that they can run their own program on the same instance of OpenLMIS and keep it separate, thereby realizing some economy of scale in terms of hosting, support and maintenance, updates, etc. -- this is a key point worth repeating to any/all countries that cannot or do not want to have an integrated supply chain.

EPI logistics team has received a ton investment into SMT.
They (Gavi) will see what USAID does and follow their lead.

Acasus

Three sets of Gavi SCMs (Cyril for Moz, Hamid Resa for Pakistan, Emmanuel for DRC) talked about Acasus and the consulting work they’ve done with country EPI programs.
As a next step, both for the OpenLMIS data analytics side as well as the Community's EPI implementing partner value add, it would be good to reach out to Acasus to figure out synergies in working together.