MIS Deep Dive and Supply Chain Information System Maturity Model at PSM July 11, 2018

MIS Deep Dive

Agenda and Notes attached:


Resources:

The following are draft.

Attendees:

Kyle Duarte, PSM

Lindabeth Doby, USAID


Ramy Guirguis, USAID

Joe ___, Systems Strengthening

___, PSM Pakistan

Haley Trager, USAID

Johnathan Man

Kaitlyn Roche, PSM

Ralph Titus, PSM

Eric Takang, USAID

Clement Ndongmo, PSM

Kristina Brown, USAID

Parambir Gill, PSM

Scott Tubin, Warehouse 

Erica Eng, MIS support manager PSM

Ralph Tituts, Warehouse

Paul Downey, JSI (?)

Malawi Team, Rwanda Team (remote)

Kaleb Brownlow, BMGF (remote)

____, USAID (remote)

Nuran, PSM Malawi OpenLMIS (remote)

John Jensen, PwC, work in South Africa (remote)

_____, Global Fund (remote)

Linda Gutierrez, USAID


Welcome!

Kyle Duarte introduced the day's objective (see agenda attached).


Malawi OpenLMIS

Presenters: Nuran Idris Adris Mallya & Parambir Gill

- Overview: old MS Access Supply Chain Manager tool used over a decade

- New system, OpenLMIS v3.x live as of August 2017

- OpenLMIS used for reporting, requisitioning and ordering from CMST

- 43 sites report directly into OpenLMIS

- most of 680 facilities still collect data on paper, data entry at district levels

- had so much volume, had to open extra data entry sites to handle volume

- reporting rates have been rising

- number of orders places in OpenLMIS has been increasing

- What were key success factors?

1) government support

2) the tool complements existing process flows, not reconfiguring process to match a tool

3) involve end users and key users in UAT and Training

- What lessons were learned?

1) harmonization of master data is critical

2) change management is essential

3) user needs, including ease of use for low-IT skill users, and limited internet connectivity

4) existence of strong logistics process is a critical foundation

5) phased implementation--just started with the critical features to replace Supply Chain Manager

- What are next steps?

1) integration with other systems, including DHI2 to triage between LMIS and service statistics; and CMST ERP system to automate transfer of orders from OpenLMIS to central warehouse

2) pilot other functions of OpenLMIS (stock management) in a few health facilities


Rwanda E-LMIS 

Presenters: Max Kabalisa and Kyle Duarte

- background: The commercial off-the-shelf LMIS system is called OneNetwork. It has been a journey.

- the ERP is an old product by SAGE

- over 1200 users are in the system for reporting every month

- they have totally gotten rid of the paper-based system! it is all electronic in OneNetwork.

- the E-LMIS implementation goal was to integrate supply chain processes with other business functions (see slide for more)

- while paper and electronic were both in use, there were challenges with data

- fiber optic internet and support for health facilities getting modems were critical

- in 2018, now working on software maintainability and reliability, and transfer of ownership to MoH

- integration with SAGE L500 and with DHIS2 is in place

- over 6600 SKUs in use (Mary Jo Kochendorfer (Deactivated) FYI)

- they have a "clone form" function to copy and edit your previous order (Christine Lenihan FYI)

- What are Key Achievements?

1) Reduced order processing cycle time from 5 hours to 45 minutes (and reduced workload from 4 people to 1 person; increased time for patient support)

2) improve visibility

3) improved wastage and expiry management

4) also provides info for quantification, audits

- What is Next Work?

1) More work on dashboards for better visibility

2) More work on integration with Electronic Medical Records

3) Automated order management

4) Working on GS1, need a Product Registry at the country level, need to work with new Rwanda Food and Drug Authority system (Josh Zamor FYI)


Q&A

- Question from Brandon: How did you reduce the data entry burden?

- Answer from Max: The system has dropdowns to select products (no typing); also when receiving you can click the order number and it automatically updates your inventory; in many places typing is reduced to just entering the quantity figures and having other data pre-populated

- Question from Paul Downey/JSI: Did you eliminate all paper, including bin cards? 

- Answer from Max: No, just eliminated the monthly paper reports and requisitions. There are still paper stock cards; users do not feel this is an issue for them.

- Question from Paul Downey/JSI: Regarding interoperability with the ERP.

- Answer from Max: The ERP is the system of record; the same products are in the ERP as in the E-LMIS.


Nepal eLMIS

Presenter: Joe Shobe

- Background: Nepal had a system called "Online IMS" across district stores, central warehouses, and some locations using the "Offline IMS", and health posts were reporting on paper

- In 2017 chose a commercial system called "Intution" developed by a company in SriLanka to power their eLMIS.

- Mobile devices are used to store real-time transactions, movements, receipts, etc.

- The goal is to automate reporting; nothing left to key in to the system to prepare a report.

- A current roll-out is in progress (see Phase 1 Overall Status screenshot)

- What challenges have they faced?

1) many warehouses not ready for batch management (and FEFO, because of bad warehouse layouts).

2) Change management is not adequate

3) physical inventory difficulties (gaining sign-off on adjustments hard to achieve)

4) software readiness and network performance have been issues


Q&A

- Comment from Kyle: Similar issues and challenges in all 3 cases--master facility list and master product list.

- Question: Regarding integration like LMIS-HMIS integration, who is going to use the data, and for what purpose? Also integration with Lab and Pharmaceutical systems--the users are different?

- Response from Ramy: We can go deep in functionality and forget about the user, but we need to put the main user first.

- Response regarding Malawi: We found in Malawi we had adequate Malaria commodities, but we kept stocking out. By looking at the HMIS data (manually), we started finding the discrepancies, we found that there weren't that many patients with Malaria, and we found that some of the root cause was theft.

- Example from Mozambique: We found higher consumption at facilities closer to interstates and borders by looking at GPS data, and it helped us identify theft and pilfering of products.


Traceability Enabled by Global Data Standards

Presenter: Kaitlyn Roche

- Major challenges: Master Data Management, Data Quality, Interoperability

- Defining End-to-End Data Visibility, and Track and Trace (see 2 screenshots)

- Defining GS1

- EG, we see different SKUs used in ERP systems versus LMIS systems

- What is our Vision? 

1) Align existing LMIS master data to GS1 standards and establish governance mechanisms

2) Develop national master data registries and MDM governance across systems

3) Enable master data exchange with registry via GDSN

- It's a multi-year effort. We also have to get Supplier data into the GDSN so the benefits are there.

- Ghana and Rwanda update: We had 2 STTAs:

1) In Ghana they are implementing OneNetwork as their LMIS. They don't have an existing system, so there is a lot of work to develop a national codification scheme. Built consensus to use GS1 and GLNs as the format to identify their data.

2) In Rwanda, working on barcode scanning (missed content here)

- What is coming next? Country Implementation Guidance.

- Centralized Model for Existing Tech Landscape (see screenshot)


Developing the Community

Kyle: With so many projects happening in so many countries (see slide), how do we build the community capacity?

- For Open Source, how can we build a community?

- For COTS, how can we address affordability?

- Could we have regional support, like an African support base to support OpenLMIS over future years?

- Brandon: We should help ministries take ownership over IT support of multiple systems.

- Ramy: IT and systems in Africa have evolved a lot in the last 5 years.

- There are lots of local IT companies that are supporting the governments in many of these countries. We should tap into that resource and help build their capacity to support these systems.

- What is the value of these interventions? We need to build the case for the country to budget and sustain this work, and plan for that from the beginning.

- What should our advocacy and messaging be?

- Perhaps we need to start a cost share with countries, even 5% or 10%, so countries have a stake in part of these IT costs.

- On the supply chain side, we are moving to 3PLs and 4PLs; so it is the same for IT systems where we need countries to work with private parties.

- How can we get local organizations to have the competency to help us do this?

- If there is vendor management needed to keep the support relationship going, we need to build that into our implementation plans.

- EG, in Nepal we had an international vendor, but also had a requirement for a local vendor to help it go to scale. 

- Is the MoH the right owner for IT systems in country? The MoH budgets are restricted. Perhaps these need to be national IT systems owned by the government higher up, and the MoH is just a beneficiary.


Other Digital Technologies - TransIT

Presenter: Scott Dubin (/wiki/spaces/OP/pages/492142682 and Sensors)

- Working with Arizona State University. Also developing an electronic POD app. Chemonics owns the app and the intellectual property.

- Why is this needed? 

1) Transportation is an important part of our work, so we should have a consistent system across countries. 

2) We want to monitor performance metrics and cost metrics of our transporters consistently across countries. 

3) We also want to validate PODs much faster (rather than waiting for weeks).

- What is TransIT?

It aggregates end-to-end data from distribution planning through delivery to the recipient, to track performance, location and costs.

It produces an instant report card to see trends.

- What are the benefits?

Greater visibility and decision making. Ability for donors to share trucks and reduce costs.

Drivers use the mobile app, and Finance managers use the data.

- What is happening now?

Continue Lesotho testing, also hoping to testing Mozambique next fiscal year to manage 3PL providers (FYI Dercio Duvane and Christine Lenihan).

Going to HHL conference to present work on temperature monitoring.

- Also doing RTM work, not for cold chain, but for dry goods in warehouses. They want to know what heat and humidity they are exposed to.

- Mozambique research (see slide)


Other Digital Technologies - One Network / Nigeria Control Tower Project

Presenter: Kim Shelby (One Network)

- Goal: One source of truth, one system of record (no trackers).

- Worked with McKinsey and then Anorama (spelling?) and identified One Network Enterprises. It is the chosen Control Tower solution.

- One Network includes tools/technologies but also process.

- It is an "overlay" that pulls data from all the existing systems in place, eg LMIS, WMS, Transportation Management (TMS).

- It is a "network" approach where all parties receive updates of all data at the same time.

- Current Status: Pilot in Nigeria. 

- Every day we get live data from all 12 distribution centers.

- Navision implementation for 19,214 service delivery points (health facilities). They are using paper and a PSM employee at the MoH is entering them into Navision. The goal is for SDPs to enter the data in themselves. About 500 of the facilities are responsible for 85% of the product.

- Control Tower will be integrated with ARTIMIS, LMIS, and WMS

- also using an ePOD application on a smartphone

- Control Tower will be handed over for country ownership


Other Digital Technologies - OpenLMIS

Presenter: Brandon Bowersox-Johnson

(source Google Slides: https://docs.google.com/presentation/d/1VZwYbBBlxR2V206lIBZcCVLzNYPn06k1HmEH_sDo-Rk/edit?usp=sharing


Closing Remarks / Next Steps

Kyle: What are topics for future events?

- Sustainability (getting partners for Tier 1 / Tier 2 support)

- Country Case Studies

- Need to keep working on interoperability, global standards, traceability

- Next time encourage other implementing partners to join the conversation (BMGF, Global Fund, etc); to share their investments


Supply Chain Information Systems Maturity Model


Brown Bag 1:30-2:30

(lots of attendees in the room and on the phone)

- Introduction by Swaroop Jayaprakash

- Transition from reporting to transactional data capture -- it means you track it as it happens and don't need to do data entry later

- What are Supply Chain Information Systems? (see slides)

- Uses SCOR and APQC (American Productivity & Quality Center) Process Classification Framework

- What is the Model? It is an Excel spreadsheet where countries can see their As-Is and build a roadmap of what they want to prioritize and implement.

- Ramy: We view this more as a planning tool to develop your own roadmap. We did not want to position this as an assessment tool.

- This was developed during work in Nepal.

- Nepal Example: Joe Shobe, who works in Systems Strengthening

- Story of Henry Ford using a rope in the assembly line.

- Nepal started with an eLMIS implementation.

- They evaluated current systems and processes to identify gap between current and planned.

- Of all the capabilities my technology can support, which should I implement first? And which process and people issues to tackle?

- This is not a one-time tool. You can use this tool frequently to re-assess what you have learned and achieved.

- Q&A: Can you jump steps? Discussion: We really need to bring the prerequisites into the model. 


Workshop 2:30-5:00

Attendees: Joe Shobe, Systems Strengthening

Kyle Duarte, PSM

Ramy Guirguis, USAID

Khalid Mohamed, PSM Pakistan

Swaroop Jayaprakash, Solutions Architect

Christina Brown, Supply Chain Analytics Intern

Jonathan Man, PMI

Nikil Patagil, Cambodia

___, USAID, Family Planning Technical Advisor

Parambir Gill, PSM MIS

Jake Watson, DIAL

Joe Shobe, PSM


System Hierarchy feedback:

- Objectives of the Workshop: "Test" the draft model by running through example scenarios. Provide constructive feedback.

- Open Questions: Should it be called a "Maturity Model"? Is the structure of it correct?

- There are more concepts to put into this model, such as track-and-trace, batch-level.

- Ramy suggests dropping "Strategic", "Tactical", "Operational".

- Feedback on cross-cutting areas like M&E, Data Analytics.

- Add specific capabilities for Control Tower.

- Ramy raised whether it should be called "Product Master" or just "Product Information".

- Also need to add "Product Registration" about the regulatory perspective of what is permitted in country.

- Integration with DHIS2 is another key area. US Health Care systems are starting to align these and to look at the combined data for demand planning. We want to know WHY I'm using inventory, not just THAT I am using inventory.

- Where does Dispensing fit? It involves patient records, EMR, etc. "The end of our supply chain is the patient, not the SDP." It is very different at a hospital or at a service delivery point. Perhaps we can expand the scope of this model to add in Dispensing in future versions.

- eLMIS-DHIS2 is becoming a much more common request from countries now.


Pakistan 

cLMIS example (scenario) introduced by Joe Shobe. 

- cLMIS is used for inventory management in the Central WareHouse, and for reporting in all other locations (health facilities, districts, provinces). 

- It provides Reports, Graphs, and Maps.

- Also vLMIS is deployed nationally for EPI functions. (One province has a special tool that interfaces data in.)

- Pakistan plan is Integrated SC MIS. Bring both systems onto a single platform and modernize the tech platform. Add VAN concepts for analytics and alerts.

- Pakistan wants Supply Planning. I want to see my data and execute my recommendations within the same software system.


Malawi 

OpenLMIS example (scenario) introduced by Parambir Gill.

- 680 Health Facilities submit monthly to district where data entry occurs. Data in the system is about 1 month old.

- It covers 6 programs and ~800 products (although CMST has a catalog of 3000-4000 items).

- Data is both a Report and Requisition, with an approval process, and it converts to an order for CMST order fulfillment.

- Data quality and availability is improving, because of arithmetic validations.


Team Break-Outs: Pakistan and Malawi

Malawi "Order Management System" Maturity:


FYI Christine Lenihan



Wrap Up 4:30pm

Next Step is to refine this based on today's feedback. It will get a new template and updated info.

This model will be ready not ready for governments to use on their own without support, but instead for PSM and USAID Missions to use as a tool. Experienced practitioners should have a discussion based on this tool and share the output and recommendations with Governments and stakeholders.