Supply Chain “Early Warning System” for Family Planning, HIV and Malaria Commodities using Mobile Phone Technology Shows Promise 1

Early Warning System (EWS) Development and implementation of the EWS in Ghana has been a collaborative process involving many partners, including: o Ghana Health Services o USAID Ghana Focus Region Health Project (FRHP) o USAID|DELIVER Project 2

Background  Non or incomplete stock status reporting from facilities for decision making at the higher levels  Irregular ordering (not based on max/min, re-order levels)  Resulting in stock out of commodities at all levels (Facility, RMS, CMS) 3

Rationale  Assist facilities to better identify and address failures in the supply chain system and manage products’ stocks better  Improve visibility of commodity stock data at facilities and higher levels for managers and other stakeholders so that they take timely remedial action  Assist the health services to ensure consistent availability of commodities at facilities 4

System Objectives  Provide near real-time stock status information for tracer commodities in FP, HIV, and Malaria commodities  Improve the timeliness and accuracy of paper- based reporting by the SDPs  Maintain appropriate stock levels and prevent stock outs  Inform and improve supervision of the supply chain system 5

Sept 2010: Concept paper by USAID Focus Region Health Project Jan-April 2011: Software development and Pre- test April-May 2011: Training conducted June-December 2011: Piloted in 6 districts in the focus regions and 113 facilities in the seven other regions January 2012: Internal assessment November 2012: Expansion started 6 Timeline

Implementation  System designed and set up  Service providers trained  Participating DHMTs, RHMTs, and Central level Managers oriented on using the EWS website  Stocks data reporting started June, 2011 and is ongoing  Monitoring and supportive visits conducted – Desktop and on-site visits 7

P&S Regional Health Directorate RMS SSDM National Programmes District Health Directorate Health Facilities CMS Logistics Management Information Flow Routine/paper flow of communication System messages EWS website access 8

How it Works  Facility worker enters stock counts and stock receipt into personal cell phones in the format: COMMODITY [STOCK ON HAND]. [STOCK RECEIVED]  Sends weekly by SMS to a toll-free short code (“7000” for MTN and “1902” for all other networks except Tigo & Glo)  Data analyzed by web database, feedback to facilities via SMS and to managers via SMS and web 9

Screenshot 10

Coverage  Reporting on a total 27 tracer commodities (for Malaria, FP, and HIV)  FRHP: 88 sites (health facilities and regional medical stores) in Central, Western, and Greater Accra regions  USAID | DELIVER PROJECT:113 ART sites in the 7 other regions of Ghana 11

EWS Assessment Results  Weekly reporting rates by facilities - 84% and 78% was timely  Over 90% of health facilities were using bin cards for FP commodities and almost 80% had them updated  EWS reports were consistent with 70% of bin card records available at facilities  Reduction in stock out rate: 32% to 24%  44% of managers had registered and used the EWS website 12

Weekly reporting rates of 84% on average 13 Weeks

Percentage of facilities with stock keeping records for FP commodities 14

Scale Up  Designing of the website improved to make it user friendly  Provide monthly reports directly to managers via and SMS  Expanding geographical coverage in the focus regions to 12 more additional district and all ART sites in Ghana  Expanded the list of tracer commodities to 43 15

Conclusions  The EWS provides real time stock status for management use  The system has strengthened stock management (use of bin cards, other paper- based reporting)  Improvement in stock out rates at the facility level  Service providers make ‘extra’ efforts to keep stock due to visibility of stock reports 16

` Please visit the Early Warning System website: ` 17