1. How computerized immunization information systems can improve Vaccine Stock Management WHO EURO lessons learned Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014 Dr Oleg Benes Vaccine-preventable Diseases & Immunization Programme Division of Communicable Diseases, Health Security and Environment, WHO Regional Office for Europe

2. Presentation outline  Vaccine management context in EURO  Lessons learned: – Which way to go? – Potential benefits from electronic IIS – Main functionality requirements – Operational considerations – Identifying key indicators – Defining & Flagging Alerts – Managing risks Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

3. EVM assessments average Scores, EURO countries, 2011-2013 3

4. IT technology in vaccine stock management: Which way to go? 8-9 Dec 20114 Providing guidance: Supporting development of national systems/modules Providing products: wVSSM- Vaccination Supplies Stock Management software (web based) Essential: Sharing and learning from country experience and lessons learned!

5. IT technology in vaccine stock management: Lessons learned  General: – Ongoing in-country investment in IT development – Important achievements & Missed opportunities – Need for both: Tools & Guidance – National regulations on registries/IT systems/IT products – Local IT development capacity available – Challenges in formulating Functionality requirements – User centered customization required: product documentation Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

6. Benefits: Management process  Planning: – vaccine forecasting, – vaccine financing – vaccine procurement – vaccine distribution  Monitoring – standardized data and indicators, – timely/complete reporting and statistics  Decision making: – Lower levels - empowered to demand – Higher level – informed decisions Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

7. Benefits: Performance / outputs  Resource management more effective / efficient – avoid stock-outs & over stock, – reduce/prevent wastage;  Reduce health disparities; – Improve access to products – Supply matching demand  Patient safety and immunization surveillance Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

8. Functionality requirements (I)  Tracks receipt, distribution and use of vaccine; – Retrieves information about stock status of vaccines, diluents, and other related supplies. – Estimates vaccine wastage by different vaccine presentations/formulations;  Vaccine ordering facility: – Submit a supply request; – Issue an order; – Receive/despatch confirmation;  Integrates Cold chain inventory; – adequacy of the net storage capacity; – equipment management.

9. Functionality requirements (II)  Vaccine & supplies forecasting; – based on population targets – based on previous consumption patterns – based on session size  Vaccine safety – Matches vaccine & Temperature monitoring data – Lot traceability – Managing recalled lots  Patient safety and immunization surveillance – Matches vaccine vial data & person data; – Computes AEFI rates /administered doses; – Identify risks (time, place, person); Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

10. Operational considerations  Access: – Different categories of users – Aggregate/versus individual data; – Records and reports by different levels;  Language: – Easy to translate – Running multi-language networks;  Integration: – modules of health information systems – other registries / supply chains; – different types of facilities ( i.e public & private, outpatient & inpatient, pharmacies, schools, etc.) – accounting and audit requirements;  Customize/adapt software to local needs; Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

11. Identify key indicators  Stock levels: doses/months – Safety stock, – Min (reorder level) stock, – Max stock,  Adequacy of supply – supplied / needs  Stock utilization – used / supplied  Vaccine wastage rate/factor: – wasted / supplied In opened vials In unopened vials By product, presentation Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

12. Identify key indicators  Sufficient storage capacity: – Required / Available  Storage/transportation temperature: – Continuous versus 2 times/day – VVM status (issue/receipt) – Freeze indicators status (issue/receipt)  Cost indicators of vaccine & supplies – Ordered – Used – Wasted Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

13. Define & Flag Alerts  Stock out / Overstock – Supply > Max stock, OR – Supply < Safety stock  Hazardous temperature exposure of vaccine – Freezing (<0  C), OR – High (>10  C)  Insufficient storage capacity – Required/Supplied capacity > Available capacity  Products in stock with short expiry dates – Expiry date < Supply period  Adverse event following immunisation (AEFI) Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

14. Managing Risks ISSUES  Lose of data due to computer failure and virus attacks  Implementation failure due to lack of follow-up from higher-ups & high staff turnover  Records Completeness & avoiding Duplication ACTIONS:  Regular back ups  Follow-up checklist  Continuous training  Functional Standards  Standardised Coding  Product Identifiers  Deduplication process, tools and methodology Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014

15. Thank you! Using information and communication technology to improve immunization programs Stakeholder consultation, Istanbul, 11-13 November 2014