By expanding the reach of its vaccine management information system, Pakistan is poised to increase immunization coverage and save thousands of lives from preventable diseases through greater data visibility.
There are only three countries in the world where polio is still present. One of these countries is Pakistan. As Pakistan’s health system battles polio, it also sees thousands of children die each year from preventable diseases, such as measles. These life-threatening challenges are made worse by Pakistan’s difficulties with immunization coverage.
Pakistan has struggled with inconsistent data reporting, which leads to challenges for forecasting. The most recent Demographic and Health Survey, covering 2012 and 2013, showed that only 54 percent of children nationally had all their required vaccinations, even though reporting from provinces suggests coverage closer to 80 percent. This lack of consistent data on immunization is one of the major causes of inaccurate coverage estimates, which in turn leads to ineffective supply management and forecasting. For example, Pakistan currently procures 150 percent of the vaccines that it needs for 100 percent coverage. Without accurate data to inform demand and supply, vaccines can’t reach those who need them most.
To collect vital information about the availability and usage of vaccines, Pakistan needs a tool that can effectively monitor, quantify, and share data on vaccine supply chain management. The Vaccine Logistics Management Information System (vLMIS) does just that.
“This scale-up graduates Pakistan to a new arena of vaccine supply chain management whereby all districts of Pakistan will be reporting on a single platform in a uniform format, introducing data visibility, transparency, and governance like no other time in the country’s history.”
Dr. Saqlain Ahmad Gilani, National Program Manager of the Federal Expanded Program on Immunization (EPI)
Scaling Up to Meet Demand
In 2014, in collaboration with USAID, Pakistan’s Ministry of National Health Services, Regulation, and Coordination launched a web-based vLMIS in 54 priority districts for polio. After experiencing improved insight into stock status and consumption, which enabled districts to better plan their procurements and coverage campaigns, in 2015 the provincial government of Sindh requested that the vLMIS be instituted in all districts and towns in the province.
By 2017, the national government decided to scale up the vLMIS beyond the 83 districts and towns (out of Pakistan’s total of 161) where vaccine and cold-chain data for temperature-controlled supply chains was being reported monthly. A vLMIS scale-up activity in December 2017 and January 2018, supported by the World Health Organization in partnership with Chemonics through USAID’s Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM) project, expanded data visibility for vaccines to 116 districts across Pakistan. GHSC-PSM is supporting USAID, the President’s Emergency Plan for AIDS Relief, the President’s Malaria Initiative, and other donors in their efforts to build better visibility to aid government decision-making, using more analytical, data-driven methods to help with supply planning. By pioneering the use of several promising technologies, such as the vLMIS, GHSC-PSM works with host-country governments — including Pakistan — to improve their supply chain processes and increase end-to-end data visibility.
“This scale-up graduates Pakistan to a new arena of vaccine supply chain management whereby all districts of Pakistan will be reporting on a single platform in a uniform format, introducing data visibility, transparency, and governance like no other time in the country’s history,” said Dr. Saqlain Ahmad Gilani, national program manager of the Federal Expanded Program on Immunization (EPI).
Building a Workforce to Eradicate Preventable Diseases
A new vLMIS platform solves the many technological problems facing unification of vaccine supply chain data in Pakistan. But what about the logistical challenges? Given limited resources, it is especially hard for Pakistan’s health workforce to create and maintain sustainable systems. To mitigate this problem, the scale-up activity used a “training of trainers” approach to build the long-term skills of federal, provincial, and district employees from Pakistan’s EPI.
Over the course of three days in December, more than 400 government officials from 116 districts took part in hands-on training exercises that included a comprehensive participant guide and job aids. The identified master trainers (MTs) also attended tailored sessions on vaccine supply chain, cold-chain equipment management, inventory management, and consumption reporting; in turn, these MTs delivered the same training to the district-level vLMIS operators. According to a comprehensive evaluation conducted through pre- and post-session tests, the MTs increased their understanding of supply chain basics and operating the vLMIS by 51 percent.
vLMIS trained district operators
districts in Pakistan with scaled up vaccine data visibility
government officials from 116 districts took part in hands-on training exercises
In just 12 days, 1,536 district operators, who are responsible for monthly reporting, also received training in using the vLMIS. Chemonics entered data on consumption and inventory management covering the period from January to November 2017, and the district operators began entering data from December 2017 onward. The session’s evaluation demonstrated that district operators increased their overall understanding of the system by an average of more than 30 percent.
Through the scale-up activity and training of these operators, Pakistan is starting to establish a district-level task force that will lay the foundation for timely and accurate data reporting. With the new level of data visibility achieved by the national scale-up of the vLMIS, Pakistan is one step closer to stopping preventable diseases from taking unnecessary lives.