Development of Electronic Logistics Management Information Systems (eLMIS) in Immunization Supply Chain Management

In Myanmar, the United Nations Children's Fund (UNICEF) is supporting the Ministry of Health and Sports (MoHS) in their efforts to improve immunisation supply chain performance by strengthening the collection, sharing, and use of supply chain data. This case study highlights the key steps that a country can take in deciding whether an electronic form of its logistics management information systems (LMIS) will be a worthwhile investment in the short and long term, and how the specific needs of the Expanded Programme on Immunization (EPI) are crucial when looking at a potential electronic supply chain software application.

The EPI LMIS in Myanmar had been entirely manual, except for an Excel spreadsheet to monitor stock at the central store. Although the system was carefully maintained at all levels of the supply chain with accurate and prompt paper-based reporting, information could take several days or more to be prepared and submitted. Consequently, it hampered the ability of the Central EPI (CEPI) to respond to supply chain issues in a timely manner or accurately identify performance issues. Furthermore, it was difficult to track stock movements across levels of the supply chain and time-consuming to know the stock situation at a given time at any level of the supply chain. There was also a lack of real-time monitoring of vaccine stock temperature and no automated alert system when there are temperature excursions.

Thus, discussions about an electronic LMIS (eLMIS) for EPI began during development of a Health Sector Strengthening (HSS) proposal to the GAVI Alliance in 2016. UNICEF began supporting CEPI to improve the use of data in the immunisation supply chain in 2015. As a next step toward standardising and streamlining data flow, UNICEF is also supporting the MoHS in selecting and implementing an appropriate eLMIS approach.

The case study outlines the steps involved in the data for management intervention. In short, the process involves: determining preprequisites for an eLMIS; mapping existing systems; and defining the objectives and features of an eLMIS. As a result of this time-consuming review process, developing a new eLMIS approach for EPI was considered appropriate, which could be integrated with other systems.

As of this writing, Myanmar had not yet established an operational eLMIS for EPI, but a number of lessons have been learned:

• Improve data use for management of the supply chain using existing paper-based systems, including identification of key performance indicators and use of data visualisation through dashboards, before selecting a specific eLMIS approach.
• Secure funding to establish and maintain an eLMIS prior to adopting a specific system. Decision-makers must be made fully aware of the initial and recurring costs – software and maintenance, licensing and data security, and user support – as well as the benefits and challenges of each available eLMIS approach so that the system selected can be sustained in the longer term.
• Establish and support an information technology (IT) governance structure and approach within the Ministry of Health to oversee the coordination and use of systems through the development and implementation of policies, guidelines, and standard operating procedures.
• Prioritise complexities of real-time cold chain equipment and vaccine stock temperature monitoring when selecting a suitable eLMIS approach.
• Focus dedicated human resources on eLMIS for EPI for a significant period of time, possibly up to 5 years or more, to allow personnel to undertake a comprehensive assessment of prospective eLMIS approaches, secure agreement on the reports contained in the eLMIS, and deliver training to all relevant staff in use of the eLMIS throughout the country.