 Hello and welcome everybody. Can everybody hear me well? Yes? Okay, good. Welcome to this DHS2 LMIS tech session. Alright, so my name is Brenna Horst. I'm the LMIS technical lead and very shortly you'll be presented with by George McGuire who's our LMIS technical advisor. Alright, so I'm hosting the session and George will be presenting. Following George will have ICRC, so the Red Cross presenting their PSM tools for transaction based stock management using DHS2 and integrated with the central ERP. And then we'll be finalizing the session with a presentation from Zaby Comron from UNICEF. We'll present Thrive360 as a national control tower for immunization supply chain. So those are the three exciting sessions we have for you today and I'll just give a very brief preface to the session just to set the stage for what you'll be seeing here. Alright? So as I said, George and I are working here at the HISP Center at the University of Oslo as the LMIS core team. We have a few people that are joining to support our work and then we're promoting this within the DHS2 community for using DHS2 within the LMIS field. The preface or kind of the introduction to the session that I want to give is that we've been here for just over two years developing this what we call a best practice approach. But DHS2 has been used for stock management and cold chain management for many years long before George and I joined the team. We came on board then beginning of 2021 very much as a pull at this was being done in different ways in different countries. And then our main task was to come up with this best practice. How do we promote how DHS2 should be used and also not used and not overused to ensure that you're meeting requirements for efficient and a standard supply chain management. Alright? So within that approach, we've worked on stock management, cold chain and biomedical equipment management and temperature monitoring. We'll be presenting two of those the transaction based stock management tool the real time stock tool, which Marta also alluded to in the presentation this morning. George will also show the cold chain equipment management configuration and tool. The third pillar of that the temperature monitoring something that is still under development but we have Philip Larson here with us who was the app competition winner last year who developed a pilot and MVP which was tested in this project and then we're looking for partners who will join with us to work together on that on the temperature monitoring, but we're excited about that as well. Alright, so then what we're focusing on with this approach is last mile. So really focusing on facility level management, digitizing facilities and integrating that with the central level tool with an ELMS or ERP. So very important and this is what we say again that we should use but not overuse DHS2 when it comes to supply chain management. We really promote integration. We invited multiple ELMS partners to join us at the conference we have a Matthew from I plus solutions who's working with the Medexas ELMS. We have a large delegation with from M supply, Craig and others so welcome to you guys. We invited others as well who couldn't make it but we really promote exploring what suits your country and your needs best. We promote of course using DHS2 at the last mile and we'll work with all of these partners to integrate to provide end to end supply chain management. Alright, we'll be available after expert lounge use case bizarre will be omnipresent during the conference feel free to reach out to us. Alright, so without further ado, I hand over to George McGuire. Okay, thank you very much. Okay, I will only present two slides and then do something risky to try to give you a demo. It won't be as much fun as in the morning. I'm not the trained actor, but I hope the system works right. So just to set the stage what is the problem we are trying to solve right because we are giving a solution. I'm going to go on and on about it, but of course, we shouldn't lose track of the problem. So this is a short introduction to my lifetime drama about stock outs of 30 years. So I trained and worked as a nurse. That's a place I worked in the intensive care unit in Austria. I always wanted to become a humanitarian worker so they sent me to this lovely place Afghanistan, like sorry has been there many people have been there. I was a nurse. I didn't have any logistics training I was in charge of managing quite a sizable stock like a warehouse actually for some hospitals and some clinics. And there was I thought it was doing everything right recalculating you know taking an effort counting my stock. But I had a problem that was stockouts right so every logistic knows that my that couldn't quite figure out why I had that stockouts why the lead time was long and I was calculating and recalculating and it didn't seem to get any better. So I figured it was time to do some learning I went to Grand Street University to study logistics. And there I had a enlightenment on a session of what about demand distortion the forest effect the bullwhip effect. And I understood this is one of the problems why there are so many stockouts and shortage or why I had them, but I'm sure I'm not the only one. So I went on to study for for a PhD. And one of the main conclusions is that you need facility level data in order to reduce demand distortion. So you can see how cheap PhDs and logistics are, you know, that's like two years of research. On the other hand, I must say that I don't hear a lot of people talking about the bullwhip effect and it is pervasive. It's, it's a problem everywhere in the supply chain, even if you haven't seen it. But that's just a theory. There's only one person on the planet was actually read this paper, which is me, my supervisor. Well, so, but that's the theory it's in the library and what now I have the pleasure of working on a practical solution since five years just to mention this is my fifth attempt. I've done a university project with an app that was never used. I've developed my own app worked died. And this is the fifth version and I think we have an excellent solution. So this is a practical solution. And again, we are trying to solve the problem of stockouts and demand distortion. So why should you implement a real time tool because it gives you end to end real time visibility. You can have a digital tool that is recording your monthly stock accounts but that will not give you a real time of visibility. The objective is that of the immediate visibility day by day is that you can also that you can resolve the stockouts or I will show that the district manager can have a report of all the stockouts in the facilities are supplying and they can take immediate action today on the 12th of June and not wait until the end of June. You can share your stocks if you're on the stock, get some stock from a nearby facility which is overstocked. As I mentioned and user demand minimizes demand distortion read my thesis. Also, we are aligning with the TSS gravity SS requirements. Real time stock management tool is necessary if you want to have a paperless system. If you have a monthly reporting you can digitize your monthly reports but you still need to have the day to day transactions written on a beam card and a stock card. And the real time tool is the only way not to duplicate any data recording because you've been card and your monthly report basically you're duplicating data. And the advantage of real time of a real time tool is that the daily monthly reporting is fully automated so you don't have to spend two days writing your reports. And keep in mind the ultimate objective of the whole exercise is improving stock availability, reducing even eliminating stockouts, not more reporting but of course we are conscious that you need reporting. Now next question is, if you agree on using a real time system, why should you use DHRs to as a real time system. That's because of the simplicity. You can use bar coding systems or linear bar codes qr codes. One of the main arguments of using DHS to in the first place is sustainability so it's free and open source. It's the cost you have the global his network. As I mentioned I work with the university in Switzerland to develop an app over one year. That was two professors they published a paper, but the system was never implemented because it was not sustainable. So you have a continuous improvement so you have seen spectacular. Every year you get this new improvements on you know tracker and rate back end. You can use existing global infrastructure so if you're already using DHS to in the country you don't have to set up a new system you can basically piggyback on what's existing. Which is with the HMI system so the health worker can do the ENC reporting and the outbreak analysis in DHS to end use the same system for logistics. You have the offline functionality, but we recommend that if you use a real time system that you synchronize at least once a day. You have API endpoints for integrating with LMS. So this is what we strongly recommend as a standalone system it's you can use it but it's a limited usefulness we are approach of DHS to LMS is to use the address with last mile at the facility level. But if you want to manage your logistics profession in any country for any type of commodities sooner or later you will have to implement an LMS on your P system. And one stop shop so you have the stock management plan mentioned it. I will demo quickly the equipment management and for the temperature management we would like to start a project and automated in real time daily monitoring month daily monthly reporting just to mention it's kind of free on the house. So we are not neglecting it. It's just that you don't have to basically fill in the reports yourself. Okay, I have to be conscious of time so what I'm going to demo quickly is how the real time stock management system works so what I'm going to show you is the sandbox. There's a public sandbox you can go on the website and log in so everything that you see now you can do it yourself it's fully configured. It's only if you record anything on in the sandbox it will be reset at midnight. Now with the smart explained the use case configuration up. If you go on the real time stock management it looks like any other tracker program but it actually opens the customized app. So the main path is for distributing goods, and the use case is that I'm the pharmacist at the hospital or clinic. Every day or every week the words are coming to me with a request for certain items and quantities, and I'm supposed to pick them deliver them to the world or the service or the outreach worker, and then keep a record without feeling in my bin cards. But then of course you if you have stock that needs to be discarded you can do that if you have a stock correction, like if somebody stole a cookie, I do that every day. Then you have to correct your stock and you can of course also do that. Now we try to keep it as simple as possible with a few clicks as necessary. So by default, I'm going to send the organization unit treat three wheel of drop down. Normally a storekeeper will be assigned to only one place so you don't normally have to worry about it, and then deliver to so here's a list it's an option set so you can customize it let's say I'm going to deliver this to the surgical word. And it will now show me a real time list of all the items that I have in stock. So I can search for an item as can scroll up down and just enter the quantity, but we recommend using the bar coding system. So, I'm going to give it a try so I open my barcode scanner. I'm going to scan this barcode. So if you've seen I'm going to go back to the screen. So it has actually found the item it's just a filter. So I have 10,700 in stock. And let's say I'm supposed to pick 700 I'm going to pick 700. And the beauty of the system is you see that the stock on hand updated to 10,000 in real time. Right. So that's why we call it the real time system because if you synchronize your mobile device of course, then anybody sitting anywhere in in Oslo in Copenhagen in the city anywhere else can view what you currently have in stock and it's particularly important of course for the supply managers at the district provincial level that they can follow what's happening. So I'm going to select two more items just to show that QR calls the work even better they take less space. So I'm going to take 2000 of those and that will decrease to 47,000 take one more item. You get the idea it's you do this basically all day your storekeeper. 4,000. And that leaves 1500. So now I have selected all my items I will go to review to give them a list of all the items I have picked so I can still check them and correct it and if that is, if I'm happy with what was picked. I will go and confirm. And that completes my transaction sales. That's all there is to do. Thank you. I was just testing your attention. Thank you. So thanks. So, so you missed that to the review. And I'm going to synchronize the device. Hope that works. And basically now the data is on the is on so the synchronization actually worked. And the data is now on the server. So, if you are skilled DHS to user you know don't forget you're running your analytics tables. I'll do that. I will show you just a few of the analysis that is now available with the native DHS to analytics. So this is one of the advantages. Those are improved every year. So instead of actually configuring something in your app, you can benefit from the from the native functionality and freely customize your report. So what I'm showing is just a suggestion. Just waiting for this to finish in the meantime. I didn't actually show the main line listing. So I'll jump ahead. So here, this is a list of what you have currently in stock, right? It's, it has not refreshed yet, but you can see if anybody wants in the facility or anywhere else wants to know what you currently have in stock. This is the last recorded stock events. You also can have a list of stockouts. So that's particularly useful for the district managers and you can see the stockouts not only for one facility, but you could say. Show me the stockouts in the entire district or even in the country and have a list of that. Then. Yeah, stockout days. So there's a program indicator predictor that is calculating whether at the end of the day there was a stock out or not and it is calculating this automatically so you don't need to record it anymore. It also makes it very difficult to cheat because it's automatic now. And this is a, this is an overview. Basically, it's the data is not complete, but you get the idea. You can see that on the 18th of April, you started with 2,981 distributed 111 and 2,870 were left at the end of the day. Next day stock in the morning was 2,870 and so on. So you can have a record of day by day. The transactions and this is also available as a monthly report. Yeah, stock out they can already show that. And here you have. This is particularly interesting from my experience for the hospital managers. If they want to know how much, how many antibiotics have been used by every service every word you can see here on a day by day basis for the items and which words they were they were distributed to. So, I don't know, check it the analytics table has completed. And I'm going to try to. I forgot to open the main table, which is like the current stock. So the digital stock card. Let's see if it worked. It did work. Yeah. So, sorry. Yeah, 114. So you see that here. These are the three items that I just distributed on the 12th of June at 114. Those three items were distributed. So you see it actually worked. It came from my mobile phone and it went on to the server. And again, anybody who has access to the server can view that. Okay. I think that's what I wanted to bring anything to add. Did I miss anything for the stock management. So I just have to go my nose. Okay. Okay. I'm not conscious of time, but still good. So I'm going to show the second product that we are proud to develop together with UNICEF. And that is the cold chain what we call the cold chain equipment lifecycle management. So this is a tool that will allow you to keep a digital record of an appliance from the day you install it until you dismantle it and have all the intermediate steps. So what I'm going to show you as a first step is, let's say you're setting up a new, a new device in a clinic. So I have an example here this is a refrigerator that you're supposed to set up. So first of all, what we have configured here is we have manually created the WHO PQS catalog so that you don't have to manually enter the specifications and basically upload it once with the CSV file. This is the list of all the WHO for the refrigerators. All the devices are here. And I'm going to sit, sorry, I left, I'm going to go back to my filter. I'm going to select my favorite one, which is bond James bond 007. So here you have the, this is a best trust refrigerator. You can see these are all the WHO specifications. So it's pre uploaded. You don't have to enter anything. And, but of course you had then have the specific details like the serial number and the production date that you want to add when you set up the equipment. So I'm going to select this item, this refrigerator. And I'm going to jump through a few hoops that are not maybe very intuitive, but don't worry about it. There's a training guide that explains how to do that. And if you do it a few times, you will be okay with that. So basically what I'm doing now is I'm taking this WHO entry from the catalog and then cloning it. And I'm going to set it up in a new place, let's say in this clinic here. And I'm going to say that they installed it today on the 12th of June. And you can see here, it says where it is enrolled, and I have the details. So the beauty of the system is that you can see that WHO PQS specifications are already recorded. E003 refrigerator, it's the number 07 Vestrost, it's MK304. And now ideally the new equipment will have a GS1 data matrix code printed on the refrigerator that you can just scan. This is an example, so this is according to the PQS GIAI Global Individual Application Identifier from WHO and these are the specifications that are like mandatory. So now I'm going to open my barcode scanner. So you have, I'm going to switch back, I'm just going to scan the code, right. So GS1 means that all this information is encoded in this barcode, but it also has application identifiers so the system knows exactly what is what. It's not just a text stream. And you can see now that you have the GTIN number here, you have the serial number, the GS1 data, GS1 data matrix stream, and you have the production date here. So everything is taken, you take it from the catalog, and the rest of the information comes from the label on equipment. Now you can still use select where you have set it up, let's say in the pharmacy. And then last thing if you want, you can make a picture. So I'm going to add an image. Okay, I can't show you. It says take a photo. Anyway, I'll show you the result. So I'm going to take a picture. And you see it took the picture so that you know which one is which refrigerators are often similar. So you have a record. I'm going to save this. And this is a technicality. I'm going to delete the link. And that basically completes the registration. So actually, that was just that was just the first step. I'm going to clean my filters and go back to refrigerator to see what you can do with it with the application. Okay, so I have all my refrigerators back. This is one I just registered. Yes. I should have written down where I have created an example of what you can register. Yeah, it's this one. So let's say I have enrolled my equipment. And now I will not show you all indeed, all of the steps in detail. So these are individual program stages. So you can record the equipment transfer. You can record the installation of the equipment and the training. And then let's say for the coaching inspection, if you want to have a daily reporting, let's say what a functional non functional. This is basically in this straw in this. You can have text entries, but you can also have drop down menus where you just select functional non functional, and then you save it. So the head, sorry. Press once once too many times. So the health worker can basically record the, the daily checking the weekly preventive maintenance. I think I'm going to add this is according to another WTO document that just the routines that you're supposed to do. So what are removed from the bottom of the refrigerator let's say yes. What the droplets wiped off of course you're going to say yes for everything that's, you know, we're all skilled reporters. You have the monthly maintenance, you can, you can report all the alarms. So if they're even alarm was created, you can report the calls. What, what kind of alarm it is what the calls was how it was resolved. And whether you escalated alarms. And then you can make a repair request. And again, in the line listing, you can then the coaching technician, the biomedical engineer. You can then see a list of all the facilities all the refrigerators that made a repair request, and then the corrective action is for the coaching technician then to record the action set to took the replacement parts, the findings. And if eventually the equipment can't be salvaged, then you can record the disposal. Okay, so I'm just. Last few minutes on. So this is not an actual project but Philip Larson the great has actually developed last year fully functional prototype that was demoed. We've got the app of the year word, the tries to app of the year word, and we are now seeking basically support and funding to develop to fully develop this in in the tries to so basically, there's a w h o p q s specification on the operating system, which basically requires that the equipment in future needs to have an integrated sensor temperature door opening compressor alerts, and that those are recorded on the device for one year. And we want to build an app that will read out this data was on Bluetooth. There's a requirement that at least every 15 minutes date is updated, and we want to develop a real time system that whenever, for example, you have an excursion you have an immediate alert for that. Yeah, so you can the specification say you can connect with a USB cable or with Bluetooth. It's only optional. Unfortunately, but we hope that obviously Bluetooth has the advantage that you have the real time alerts. There's many systems out there you all know them there's dozens of system commercial systems I think, maybe 10 or 12 of them are have w h o p q s pre qualification. The problem is that they require, they're quite expensive and they require annual fees. So the idea is to have a tool but to put it on a free and open source software platform. We want to have fully automated temperature excursion alerts that's the main purpose we don't want to have pretty reports that also you get it free. But basically we want that when you have an excursion you get a lot of alert immediately on your mobile phone. And if nobody's in the clinic that the mobile phone that you leave in the on the refrigerator will send an alert by SMS or on DHS to people so they can take corrective action. Daily monthly reporting will be basically automatic you don't have to measure temperature anymore just put the data put it on the nice dashboard. That I made so at the ultimate objective of what we want to develop is that you have real time alerts and that you prevent the vaccine from being damaged and not to tell you Monday morning that you had a freezing event on Saturday and all your vaccine is gone. And this is my last slide for today. This slide is, there's actually a tracker program that we have set up in DHS to. It's already ready to connect to the app right so we have the WHO EMS requirements we have a tracker program we just need the software to put it in between. And this is a chart of course it's just demo data that you can get so you can see here this is daily reporting. You have the minimum maximum average temperature we want to add the mean kinetic temperature to it. But this just gives you average temperature so you don't really know much what happened during the day, but here you can see the door opening time, and particularly the time the temperature was below two degrees, and it was above eight degrees that tells you much more than an average daily temperature so you can especially see the freezing elements. In addition to that here you have the power supplies we can see it's a 24 hour scale. So you can see here the temperature the refrigerator was running 23 have 23 hours of power, you only 19.5 here you have a major problem and the temperature went up. So you can have all this monitoring on a single chart. Keep in mind you can have all of this. Hopefully one day just by having leaving your DHS to mobile phone in on the refrigerator without having to report any day and logisticians are never on time but I am on time. All right, big thank you to George. To say we're having a small issue with getting the online presenter connected so we may have to put the Zabi on the hot seat and have him present next but we'll give him a few minutes first and maybe take a couple of questions. We have two questions online and one is pretty much the first one we get every time. Can you manage batch and expiry. The first question is we have that on the development roadmap and that's an expected improvement but for now it's generic management of items management of items. However, when it's integrated with any LMS or European we have an example of this it would be the next presentation if we get her online. That it can be done with the integration that the central system keeps in order of all items that are shipped, and then based on first expiry first out principle, you know which items are still available on stock given how much stock on hand. That's in a nutshell we can discuss and explain more how that's actually implemented in this specific case. The second question is related to order management. Can you generate orders within the system. And that's where the last mile approach comes in and where we say we do not recommend generating orders with the HS to we recommend integrating with a professional supply chain management system with the LMS or M supply or others to then say we provide you with the up to date information or if there's a hastening level from this app but then it should be a type of VMI or vendor management victory model where they generate orders and that's integrated and that's another example which also will be presented here but in the French session tomorrow afternoon where mama do some okay from. There he is. Yeah, so he'll be presenting how this was implemented in Mali. So you can see how that model works there so and that's what that was with the indexes LMS system. So that's the batch and the other one on the order management. Now one last check if Regina from ICRC is online. And if not, we'll hand over to Zabi to present drive 360 to see Regina. Zabi over to you. Hi Bruno actually I'm here sorry. We'll share some information on the ICRC implementation which was pretty much this same solution the transaction based stock management integrated with Oracle ERP. All right, in multiple projects and their scale up plan. So that's what maybe we'll still get her online by the time Zabi is ready or he's finished. Good afternoon colleagues. George was not a train actor then don't even ask me. So I'll just briefly walk us through on what drive 360 is why we started it. We are we are right now. And what makes a lot of sense that we integrated within the details to. A lot of colleagues in the room that you already know, even before the pandemic we had problem on hand, and we were seeing this steady increase in stock out supported within the low and middle income countries. And, of course, as a result of that we're also seeing the increasing number of service disruptions that were reported. And we all know the coverage rates are the same timbers also plateauing. And combine that with all the scattered data sources and there's so many different elimises in the countries, and we had a problem that created a situation where in the same countries we had excess stocks in one in place and had stock outs in other places and we will see a few slides of how the programs that the countries have implemented and of course in the covert cam. And it's already made a bad situation into worse. We have seen in a lot of places of reversing the gains that the program had made, or, or the last five or 10 years. And this is a snapshot of how the pandemic affected the immunization programs. We have about 5 million more children who are in added to the zero dose. And we have some places up to about 5% more than that reduction in the coverage rates of dbt3. And we also did the mapping. The last couple of years to see what type of systems exist in countries and as you can see there are quite a few, the 292 different type of elimises that are implemented in countries and 2400 or more. Elimises and we didn't even count a lot of other systems like these BCCs. And even in some countries, they have like five or six or seven implementation of the elimise at the same time. So one province is using the system in the other province as another elimise and what that's created is that is an opportunity loss that we do not have real time data in countries so that they could take it and make decisions that could prevent stock risky situations in those countries. But there were some implications of course for both other countries but also for us at the UNICEF. And some of them were that there wasn't enough actionable data to prevent or minimize the stock risky situations in the countries. There was a lot of sudden unexpected request for prepornment of shipments, even from countries who just a couple of months ago would report that they had stocks that would last them for another seven eight months in the next month there is a stock out and they're requesting prepornment of their shipments from from the next year. We have also did some mapping in countries where we have we can see certain geographic areas in the same country, which we're doing really bad in terms of stock performance and coverage rates, but other parts that were completely the opposite. And that's because, again, so many systems are in place in that information does not integrate and it does not go to the decision makers in a time that they could take it and make decision based out of there. So, having all of these problems we started to. And of course we didn't want to add another system to the 292 we wanted to see how we can leverage the existing tools that are in the countries and get the information out of them and give it to the decision makers so that they could prevent those stock risky situations. What drive does it is just a data integration hub. It combines the data from the stock data with the consumption with the shipments in with the monitoring and evaluation data in brings them in one platform for for managers at the different levels. So here are a few screenshots of what it does. So on a on a monthly basis we now get a snapshot of the stocks at the global level, how they're performing, where we are seeing stockouts, how they're faring this month compared to the previous how the trends are. We also have that then that with the shipment data we're just tracking whether there are enough in those countries, if there are lower stock levels in countries are their shipments online in those places or there would be some imminent stockouts in those places. But moving beyond that, not just looking at the quantitative data because it doesn't tell you all the story, it just give you a point like a half 50,000 doses of a certain antigens. But what does it mean. So we have complemented that with more qualitative inputs to say, what is causing that stock out. What are the major drivers that are repeatedly reported or months in years in certain countries so that we could find a way to address the solutions. And then of course with the code we also did try to monitor a little bit on what stock levels countries had, how they're using that stocks and what the research and expires look like. But there is a more deeper dive in the country so we look at each store level. So we look at the center level of how they're performing and they're having any challenges with their stocks in at each store at the first sub national level the second sub national level in the last three, four months we have also started taking data from the lowest distribution points or the health facility so it is expanding a little bit or the last months and so. And of course then when once you have all of that information it gives you a lot of opportunities to analyze it in different ways so we do some a little bit of projections as well at what countries as how long would that take them if there are the shipments are they going on time. And if also to do some quick comparisons of how the quality of that data is we're looking at each month but then comparing it again with the last 12 and 24 months and seeing if a country is reporting seven eight months of stock of a certain antigen and how it how did it end up having 50% of the time that they were low low stock or they were even stocked out. And of course then there is the coverage data and the red dots all denotes the impact of the pandemic on each antigen by country and again comparing it also with the global averages. So, from the last year and a half that since we implemented it there, we tried to track a little bit of did it change anything on the ground. So, one, they, of course the visibility has increased significantly we started very small within about 12 countries and just their national levels. And now it's in 63, and we're in about 7000 stores, as of the end of May. We also took some examples from the countries to see. We've heard the names they deliberately but their countries we were looking at the total number of stores in tracking that again so that we have what, what proportion of the source report on drive. Comparing the last year, the last 12 months we're seeing there is some modest improvement in stock management practices in the country and we can see that by the reduction in both at the national level at the first sub national level, and also at the the But we've also narrowed down the categories that and that causes those talk off in those countries and a lot of them have to do with the delay in funding. In some places the delay in procurement and in the lead time that that have not been followed that causes the stock price from parking. But we're also seeing there is a deduction in the duration of the stock price as well. So we'll talk a bit more about when the frequency in in the, how long those stocks out to work. So, also, late last year we started integrating on this drive into details to, and the purpose was that if we can do this type of analysis at the global level or the units of regional office level. It will make a lot of sense if we put it back in country in allow managers at the different supply chain levels within the country to take this information, and make decisions that will prevent that the stock or but most importantly, resolve the in country problems with stock management. But of course, giving them their own data back doesn't make a lot of sense right so it makes sense that if we can combine it with other critical pieces of the information in this space. And that is just to take the supply chain data and put it side by side with coverage is data like the some of these great surveys like the mix in the DHS but also with some estimation projections like unique and and the admin sources of data, but also with the evaluation in assessment data the countries have the EVM assessment in the lot of them have very rich data sources on supportive supervision so if you can bring all of this information in one place for the managers within the DHS to then which already does 70% of the job, because they are already rule based access to DHS people do not need a lot of training. So that didn't create an actionable platform for managers to prevent those stock risky situations from happening in the first place. And this is one example of how countries now track their demanded forecast against consumption. And this they can do this by antigen and at store level. So what it will tell them is that if you see that there is ups and downs in consumption in a certain month, that would make sense. But if you're taking it for the last 12 18 months and you are seeing that there is a significant difference between what they forecast that they would need and what they're using then that should alert the decision makers to take decision whether they will have a surplus within the next five or six months, or they would face a shortage. If they're facing that shortage, what should they do about it? How can they resolve that problem from happening? And also what's the implication of that shortage would be in terms of finances so they could take this decision on time and source the funds that are required to help them prevent the stock out from materialized. So these are all within the details too. Bruno and team have worked a really great job in putting all these scorecards based on the information that is within those countries in automating the data integration within the other sources. So what this does, it gives the managers a quick snapshot of their logging in from a national level to see which districts within their country has the most problems and where they have to focus. So, and that helps in channeling the resources in the technical assistant that goes into the countries on those specific areas that are performing, continuously performing below the expectation. It also provides these scorecards that gives the clusters the health facilities within those countries. For a district manager, for example, when he was she logs and he would only see the health facilities within his area or her area and they could also see what health facilities or what cluster of health facilities are contributing to the problem that they are seeing. And this will be my last slide. And this is an attempt that if we could use all of that rich information that is available within the details to enter all other systems and see if we can predict the stock stock outs and we could prevent it before it materializes and causes the problem. So this first attempt is to take a couple of indicators and create an index that would rate the districts and or the health facilities or as you go up the geographic levels. And it will take the historic stock out from the last 12 for 24 months. And, and combine that with the coverage rates. And the population of zero dose in that area and give a rating to the. Based on that, and of course, these things will improve over time. So we will test this to see if, if a certain areas that have higher probability of stock outs materializes. And if that happens then then managers in those places can take timely action to prevent that from happening. And then also, putting each of that district or health facility side by side with the zero dose population, and the coverage rates to see if a certain district has reported that they had good stock management practice in the last 12 months of four months. And if they have a 30% coverage it and they have very low wasteage rate, then we are the rest of those vaccines going and vice versa if there is a large number of stock outs reported there are lots, a high percentage of wastage but they're still reporting 60% or 80% coverage then again that's a question of where did you find those additional vaccines to the vaccine is this general. So, I'll stop there and see if there are any questions. We don't have any questions from the online but from the room if there's any questions we can take one or two now. You said 7000 reporting sites. I was just wondering the, how are you getting the data into your system. Whatever the country has. So it's a country system. If they're using an elimination limitation that information comes from there. If they're using another system, and they feel comfortable they some countries give us access to their system so we extract the information from from their system, others just dump the file somewhere and we extract what we need. Some countries that have the do not feel comfortable with sharing information and through an API or a dump. We have a template where they collect information from whatever system they use, and they share that information with us. There is also some countries who have implemented the web SMT. There is already a built in report inside web SMT where they click a button they download that information that are going to try. But it's a country, whatever the country is. To do mind if I just add one quick point that some of them are already reporting a DHS to so again, with my first point to make use of what's already there. We had a webinar just in December showing immunization stock data in Nigeria where 27,000 facilities are actually reporting about almost 5000 of those at the site so. So it's using data that's already in DHS to it's not reinventing the wheel and making use of what's in the country. Just as one one example. Claire. Hi. So I work in the WHO and interested in a lot of the work that you've been doing on LMIS. One of the things that I have is from a data perspective, WHO is empowering countries to take ownership of their data, not have international organizations having a lot of the data that is being produced on the country level. What is being taken into consideration here as well. Well, absolutely. This is the ownership of the information of course is within the WG and that's why it going back to the details to is that it would be with and within their hands. The purpose is here to strengthen the stock management within the countries and it's not something that that should be brought into an HQ. But the the problems that I mentioned in the beginning was was coming and we were seeing more and more countries requesting. Preponent of their next year shipments there was a fix on allocation levels. They were and we have some some more information they were places that had stock outs of over six to nine months at a time. So that corresponds very well with the coverage rates in those places as well. So that is the reason why we wanted to create to bring this information that is shared by the WGs to ensure that we prevent or minimize the stock risk situations. But the information is for the countries and is going back to the DJS to and it would be within the WG or the Ministry of Health. Absolutely aligned on that. Travis also been launched together with Gavin W chose it's not something that that is a standalone UNICEF initiative. And there's a monthly report that also goes to both agencies. So each thrive system is in the country. Owned. Sorry, may we'll ask question then here. It's just, I mean, this vaccines right. So my question is, anything of expanding this to essential medicines are you staying with the vaccines. So the time we only have vaccines in the relevant consumables the devices syringes and deluents. We haven't moved from from the space yet to to the rest of. Well, when it comes to details to and it's in control towers then of course there is no possibility that you open up. And that's precisely the reason why we're integrating it with details to that it would tap into all of the information that's already existing So it's not just us who create some of these dashboards, but these are the managers at the country level who were didn't customize it the way they want these dashboards to work for them. Great, so we'll stop there for this presentation but thank you again to Zaby, and he'll be around so you can come with more questions and I'm sure he'll be happy to speak to you we actually have Regina now online from ICRC so international project across who will present then their PSM project so their pharmacy stock management tool, which is the transaction based tool which George showed which is integrated in the tries to show show how they've implemented it in their projects and also how that's integrated with Oracle ERP so very relevant on the model that's being used. And without further ado, welcome, Regina. Just a moment. If you can unmute now we see the presentation, Regina. All right, can you hear me. We see you and we see the screen but we can't hear you yet. Is it better now do you hear me or still the same. Can you please confirm. Okay we see you're unmuted. Can you try. Can you hear me now. Is it better. The right speakers. Can you try again Regina. Can you hear me. We're still not hearing. Okay. Okay, so the people online can hear you but not the people in the room. If you can all go online. Is it better now. Can you hear me on that. Can we try one more time. Can you hear me. Yeah, we hear the test sound. Can you hear me now. Can you hear me now. Yes, now we hear you. Yes. Regina. We'll present the PSM project. Yeah, thank you. And good morning. Good afternoon. Good evening, everyone. I'm really excited to be joining this conference this year. Although couldn't make it in person, but, but happy to join it online and to give an insight on the pharmacy stock management tool. That the ICRC have been using since last year and the deployment is ongoing. In 2023. The ICRC will be the first to deploy the drug. The first national community of direct cross also known as ICRC as the deployment coordinator for the pharmacist of management project. The objective of this project is to deploy the pharmacist of management tool globally across the health facilities that are supported by ICRC on a regular basis. In this season. I will be covering the following different topics starting with the background, why the solution was created or developed. Why the solution and how does it work and where we are in terms of current deployment and where we are heading in the future. So I would like to start this presentation with a short introduction about the ICRC. ICRC is a neutral international organization that is based in Geneva and was founded 160 years ago. The core mission of the ICRC is to provide the humanitarian assistance and protection to the victims of war and other situation of violence today with over 20,000 employees across more than 100 countries. ICRC provides different activities starting from detention activities, but also on health, economic security, water and habitat and so on. Under the healthcare programs ICRC provides a continuum of healthcare activities starting from first aid, pre-hospital care, primary healthcare, hospital services, rehabilitation services, and as well as healthcare and detention activities. About the PSM project, the primary healthcare program is the ICRC is one of the digital health solutions in the ICRC under the digital health portfolio that is used with the aim to store, manage and also record the data, collect the data from the health facility level. It is an outcome of the project. The project was created at the beginning of 2022 with the aim to deploy the, to develop the PSM tool and also the deploy the tool across the ICRC assisted health facilities. The solution was tested in Somalia in various, in many health facilities before, before the solution went live as an official deployment. And since May 2022, we have been able to deploy in six countries and the deployment is ongoing with the target of 80 health facilities for this year. Why did we develop the PSM? So the facet of the project, we have been able to deploy in six countries and the deployment is ongoing with the target of 80 health facilities. We developed the PSM. So the facilities that the ICRC supports are supported either on the regular basis or are supported on the regular basis, which could be monthly as well as, as well as quarterly. These health facilities are the stock management in those health facilities where paper based due to the manual nature of the work. It was also very slow and was subjected to data collection methods and reporting, which also made it, there was lack of visibility of the data, which also did not allow advanced analysis and no real-time monitoring of the data. So there was really a missing piece of data at the last mile at the health service delivery level. And to, in order to overcome this problem, the solution PSM was developed with the idea to have a simple, minimal and efficient tool that standardized the stock management system and also the replenishment system of the health facilities that the ICRC is supporting. The idea is also to make the efficient and effective in press management system and to also improve the demand forecasting and stock optimization at the health facility level by removing overstock, understock or on any other stock issues. PSM solution, it integrates three different platforms. So we have a DSIS to Iris, JD or Oracle and then the Tableau. As you can see in this diagram on the left-hand side is the DSIS to data and the left-right, that comes from the health facility and on the right side is the JD, your echo and the Iris, which is the logistic management information system that is used in institutional wide in ICRC. So basically once the health facility from the health facility label, the storekeeper or the pharmacist enter the data in the mobile application. The data, once it is synchronized to the DSIS to server, it is available in the DSIS to desktop or the web portal that the program manager or the logistic program manager can use to really change the impress level to review the impress level. Once this is done and synchronized the data passes through the audience, which is our operational data store. So the data from the health side from the pharmacy or the health facility passes through the, is pushed towards the audience and also the logistic data also is pushed towards the audience and through this joint integration we have advanced analysis that gives some advanced dashboard and gives a more comprehensive overview of the whole solution in Tableau which is the data analytics tool that we use in the ICRC. So it's really an integrated solution in terms of giving a global overview of this, global overview of the stock management system through bringing in the different data elements from different data sources as you can see here from the DSIS too and also the logistic side. And there are different data elements as you can see here from the DSIS too. We take the stock on hand, the stock distributed and impress level that we take. And on the IRA side we mostly take the logistic data from the DSIS, from the DSIS, we mostly take the logistic data on the supply side but also the pharmacy item course and description and through the integration of these two information there is an advanced analysis that is available on Tableau. That really helps and guides the decision making around the stock management for the program managers. Why DSIS too? I think for us it was particularly important to for us it was particularly important because it is an open source application it has been widely used by different ministries and different partners as in CIS etc. So it was it was available as a public health good. The other functionality knowing the context where we operate it was also very important for us to have something that works offline and also in the low internet coverage so that was also one of the benefit that the DSIS could bring. And also the system the DSIS too could function on the tablets that was really an added value as well that the storekeepers or the pharmacist can use tablets to record their data whenever it is required. In addition to that ICRC had already used different DSIS to DSIS to different health information tools that was based on the DSIS too such as COVID tracker and other database as well so in terms of infrastructure and knowledge also we were equipped and it was the best solution for us to go forward with. And as I mentioned earlier because of these really this the DSIS to really allowed us to integrate the PSM system with other institutional platform particularly on the logistics side to really give a 360 overview of the of the stock management was really an added value as well to why we thought DSIS too would be would be an added value for this solution. This is a solution overview in terms of what are the different components that the tool is made up of as you can see here for us the eligibility is all the health facility that receives the donation or the regular supply from the ICRC. It is relatively simple in terms and minimal in terms of infrastructure as you can see mostly we ask tablets at the health facility level that the storekeeper can use to record their data and the computer we normally use the computers or computers are mostly used to to rebuild their impress level and also to change it so most of the time they can use what is already available in the program so no additional hardware is needed on that side in terms of length of training also it's fairly simple three to five hours training because it is very intuitive and embedded in their work every day to their work the training is also fairly fairly light and intuitive as well the other I think the added value for this solution is that it can also we have five different languages that are available in the system which makes it very much user friendly in different contexts that we operate and as you can as you can see for all the target users are medical storekeepers pharmacists but also the health program managers and the logistics logistics as well so this is just a broad overview of the different components of the PSM tool modes of application PSM has two modes of application there is the basic mode and there is the advanced mode so for the basic mode it's really about taking the aggregated stock data at the end of the month when the pharmacist or the medical storekeeper does the inventory this is the picture that you see here on the screen is a screenshot of the from the tablets so basically the first line is the line items or the pharmacy items that belongs to that health facility the first column is the impress level that has been set for that health facility as you can see there and you have the stock distributed and stock on hand where the pharmacist or the medical storekeeper enters the data at the end of every month so as you can see the solution is really simple and it's really intuitive in terms of their daily work as well on the advanced mode as the name says itself it has much more advanced stock management options we have the distribution if you see there on the screen on the picture on the top the distribution discard and correction so there are much more options than what we saw just before in the basic mode the advanced mode also allows the real-time transactions so as long as soon as the medical storekeeper or the pharmacist issues and transactional dispatch is an item to a department in the hospital he records the transaction in the PSM so it makes a real-time visibility of the data a real-time visibility of the stock moment that is happening from the pharmacy to the different departments in the hospital or other kind of health facilities one of the unique features of the advanced mode is also the use of barcodes that are tied to each of the each of the line pharmacies they say the line items so so whenever the person or the pharmacist or the medical storekeeper wants to issue something he can use the tablet and scan the barcode that is attached to them to the respective line items and then issue that and record the transaction into the system and once this is synchronized the data is available at the global labor across different management to really have a visibility of the data at a real-time so on a regular basis at a daily basis depending on when the transaction was made so how does it work in terms of the processes it starts with entering the data on the tablet at the health facility level as you can see on the first one here the medical storekeeper or the pharmacist enters the data he synchronizes the tablet and the data is shared with the DHS to server and then it appears on the DHS to wave in is visible globally at this level at the second stage the manager health program manager whoever is responsible for the impress management can review the impressed otherwise the list is ready to be put the list is ready on the iris to place an order sorry iris is the order management application in the ICRC so for here the data that has been taken from the DHS and also the data taken from the JD Oracle are integrated and there is an embedded formula within the system that automatically proposes the order quantity that has to be done based on the impressed level stock on hand and back orders however the health program managers have full rights to review and to review the items based on their context and need and they can place the order at the end stage of this process once this is done the request is being made and also the data because as we discussed as I showed you earlier thanks to the integration process the data from the data is to and the data from the iris feeds into the table giving very advanced analysis on different stock management parameters that the health program managers or logistics and the operations in terms of current deployment so far we have deployed in six countries Nigeria DRC, Democratic Republic of Congo Central African Republic South Sudan, Somalia and Yemen with one minimum one health facility to 22 health facilities per country which has been the case in for example in Somalia as you can see here in this color we have also recently started the deployment in Cameroon and this health facility as you can see is situated in Africa and Middle East so far we have deployed deployed the solution in around 39 health facilities mostly in hospitals and primary healthcare centers among these users there are three advanced users which is the case in Nigeria Somalia and South Sudan and for the rest they are using the basic mode one of the things that the solution is the scalability and by this I mean that the solution is very intuitive and very easy to use and very much embedded in the day-to-day work of the medical storekeepers and the pharmacist it has also the potential to scale up in its own for example this has been the case in countries like Somalia and also in Nigeria where we have deployed a number of health facilities but once it reaches a certain level the solution can be really deployed with the minimum support and more and more we are seeing this very different so really it's really about the simple and intuitive and minimal nature of the solution that it has shown this demonstrated this ability of scalability for us the outputs and expected outcomes that we are in visiting from this implementation is of course besides to have the simple integrated and scalable digital solution it also brings the process efficiency because of the automatization that is involved in the stock management it is also thanks to this component thanks to the automatization that this is really bringing in the process efficiency as well and one of the interesting thing is also the availability of historical data and I think this can be seen in two different ways historical if the health facility is closed at certain point and you want to revisit the data this is also something that is feasible to do as the data is stored in the DHS too also for the prediction of the demand or demand forecasting for coming years this is also something that you can do with the historical data availability and the overall objective or the long term vision is also to improve the service delivery in terms of properly improving the stock management process and thereby reducing the stock outs or overstocking and also one of the unique features or added value of this tool is that there is also a big return on investment especially in terms of stock savings and salary savings thanks to the process efficiency that it brings so we have estimated around 30% in overall stock savings and 10% salary savings now over a period of five years time we have also identified some of the factors that influence let's say the implementation and some of the tools I think these factors are more generic but you can see here the first one human resource factors the stop in a place where there is a constant on especially in the beginning this can influence the implementation process it is also connectivity is also in terms of connectivity also it's a big enabler for any of the digital solution it is also true for the solution that we are using compliance with the data protection and security protocol and by that means the regulatory environment that we work on both sides is also determining factors and that influence the implementation and some of the tool and local ownership as we all know is very important to have a buy in and also to scale up the solution at the local level so these are some of the factors that we have identified during the development process of these two across different countries so what are the next steps for us is to continue the deployment with the goal to cover around 300 health facilities that are supported by the ICRC and we are also planning to integrate other equipment other solutions such as biomedical equipment tracker tool within the same GSI environment and to really have this integrated approach in terms of biomedical equipment but also on the pharmacy stock management side so these are the future activities that we plan moving forward okay I think I can stop I will stop my presentation here and I'm happy to take any questions that that you might have. Thank you to Regina we have a question from the room here. We have a central database in our capital city but we have also distributed system and distributed database also distributed database in 64 district can you operate this by distributed system and distributed database using this is with the DHS and which country are you Bangladesh okay maybe that's a special case we'll have to look into it's not something that we've come up so far but we can definitely have a discussion about that how this could be applied to that context I think it's a local database where 10 percent 5 to 10 percent is needed to central database so it is necessary to access distributed database so we can first up for the centralized query. Okay understood I think we'll have to have a separate discussion to see if that would fix that model yeah next question Yeah I wanted to ask that ODS whether it's data warehouse or it's an interoperability layer Yeah Regina the question is on ODS if it's a data warehouse or interoperability layer Yes so it's an institutional operational data store so that really allows the different institutional database to interact with each other. Other questions from the room? I don't know if that answers your question Yes Mine is just a comment if you are going for HIS open source why don't you also consider for analytics an open source for example because like I see there are some costs with Tableau so why don't you also consider an open source for that? Yeah that's a really good question actually I mean even within the DHIS too there is a lot of data analytics that can be done and there are several other applications but for us the Tableau was really interesting because it was it is an institutional data analytics tool that has been used since many years for different kind of other logistic analysis as well and other institutional analysis so that's why we adapted consistent we adapted the Tableau as our analytics tool Any other questions from the room? Alright so I think that was it thank you again Rogina for a great presentation once we got you on it was really good to see how that's being implemented I think that's the end of the LMIS tech session I hope that that gave some ideas about the possibilities and opportunities that you have with DHIS for stocks at the beginning it's very much a use case that was already present long before George or I arrived on the scene before the University of Oslo and his center decided to invest time and effort and money into developing it so really what we're doing is guiding it in the best way possible looking for the best practice very much looking to collaborate with others within the sector so we've been very open and we continue to be open anything that you've seen that you agree or disagree with we're more than happy to hear from you and we're looking really to add to the environment there's somewhat of a fragmented at times picture I think Zabi gave a very good example of that with multiple systems implemented in the same country so we don't want to add to that fragmentation we don't want to add to the systems but I hope that it was highlighted in all of the presentations and the message that we're looking to use what's already in place and maximize that but also not overuse it and look at that integration possibility when you need really a professional system from the central level alright so thank you very much for everybody who participated feel free to approach us now if you have more questions and we'll be here for the use case Bazaar tonight and the experts lounge tomorrow and Wednesday night alright so thank you again to all the presenters Regina online Zabi George and thank you everybody for joining