By kpeuquet on July 1st, 2014

Throughout May and June, 2014 IAPHL members engaged in discussion regarding the pros and cons of adopting various types of  automatic identification and data capture (AIDC) into public health supply chain operations. AIDC options are becoming increasingly relevant in the public health supply chain community in order to promote improved data visibility. IAPHL members were encouraged to share experiences and challenges that they have faced in this area. The conversation was initiated by Mr. Liuichi Hara, a member of the UNFPA supply chain team.

Original message:

“Dear IAPHL members,

UNFPA is currently embarking on a project focused on real-time track and trace of health commodities delivered that would help enhance data for management. One of the challenges faced in the public health supply chain is the lack of quality data available as well as often times, difficulty of extracting comprehensive data sets. This prevents supply chain managers from being able to have full visibility when making decisions. 
In order to address this capability gap, we believe that adopting the method of automatic identification and data capture (AIDC) into one’s supply chain operations is one way of attaining the goal of better and consistent data for management. In other words, real-time data collection would help improve supply chain decision making through better visibility. Compounded to this, automating the data collection process could offer the potential of reducing non value-added manual data entry into a computer system. AIDC technologies such as bar-coding, RFID, imaging scanning, and voice data collection have been around for a while, but they are now seen as increasingly relevant for global health supply chains. However, like any methods or tools, there are a number of options available with each having it’s own positive and negative aspect. In effect, one technology may be better suited for adoption depending on the local context of the country (for example, the local ecosystem may cater better for bar-coding over RFID or any other equivalent technologies). Furthermore, many existing applications and tools were developed for specific uses and thus, poses the challenge of integration for an end-to-end solution. 

Based on your experience and knowledge, what are some of the challenges and issues you have seen for a project of this nature (i.e. lessons learned, warning signs to be mindful of)? What is the emerging trend for technological adoption in areas related to real-time data capture?

With any new projects, starting with a solid foundation is critical to help ensure that future investments provide the desired benefits and returns. As such, any insight or counsel from the IAPHL community members would be greatly appreciated.”

(Liuichi Hara, Denmark)

  • RFID means logistics workers do not have to physically perform any action for products to be processed, is that a good thing? With bar codes the worker needs to physically scan whereas RFID readings are taken automatically.
  • While RFID tags may be dropping in price from $0.50 to $0.20 a tag, cheaper tags are less reliable. What packaging would you attach them to? Cartons and boxes might be fine but individual SKUs and primary packaging?
  • Fast moving consumer goods companies and pharma companies are not adopting RFID as it is either unreliable or too expensive.
  • Where electricity is unreliable do facilities have back-up generators to run RFID readers?
  • 2D bar codes are increasingly being seen as the technology for track and trace but these require changes in work flow processes and infrastructure to work, they also require the right execution daily ass products not scanned will disappear from inventory. Commercial adoptions have encountered problems when workers do not follow SOPs.

(David Sarley, USA)

“The other challenges in the Public Sector settings warehouse workforce is the good understanding of the expectation of any program. This is a challenge when there is clashes of expectation because training was not well done through the whole supply line.”

(Apolosi V, Fiji)

“I think “RFID means logistics workers do not have to physically perform any action for products to be processed” is a bit of an overstatement of the case, especially if you’re using passive tags. The cheapest passive tags have a range of only 1 – 12 meters, so for example, to take an inventory, you would still have to come more or less to the pallet location to scan or the tags. Also, I’m sure you would have some kind of random spot check protocol to confirm that the items referenced to a specific tag were in reality the items matched to the inventory data in your database. You might get better accuracy and speed with RFID, and using tags may require some different skills/procedures, but people will always be part of the management equation.

In terms of what to attach tags to -or how much you’re willing to spend on labeling generally, I would think that would have to do with your security requirements, the value or sensitivity of the item and how much throughput you have to deal with. You also mentioned the electricity constraint, and while you do need power, there are a variety of rechargeable, battery-powered, handheld scanners and the computers to manage your database could have battery back-up as well for places with irregular supply. For places with no electrical power supply at all, I don’t think either RFID or bar code technology would be appropriate.”

(John Durgovitch, USA)

Like any business decision, the decision to use automatic identification technology (AIT) in the public health supply chain should be informed by results of a comprehensive business case analysis (BCA) to make sure that the implementation benefits outweigh the implementation costs.

Too often, BCAs are scoped too narrowly to identify the broader, strategic improvements that can accompany an AIT implementation. The implementation costs are apparent – there will need to be handheld scanners / interrogators, label printers, tags, etc., along with software, training, and other investment costs. The business case needs to be broad and inclusive, but it also needs to be simple and clear so that everyone involved can understand the changes it promotes. “Everyone” includes Finance Ministry decision-makers, health workers, storekeepers, and everyone else touched by the supply chain from one end to the other. If the solution involves changes in procurement, storage, and distribution policies (and most comprehensive improvement initiatives do involve such changes), it may drive changes to policy or even statutes.”

(Roger Miller, USA)

The real question–indeed, the potential game changer–is how to use technology at the point of care/service. When a pharmacist, pharmacy technician, nurse, or nursing assistant takes a whole unit (cycle of oral contraceptives, an HIV test, a bubble pack of ACTs, etc.) from the facility store at a rural clinic, can we capture that movement with technology? Certainly there are already smart phones with Apps that read 2D barcodes, and virtually every health care worker owns at least a simple cell phone, so is it feasible to expect them to use a smart phone routinely for issuing or dispensing packaged medicines? The technology already exists to make this a reality, so the real challenges are–

  • Getting both international and local manufacturers to agree on and implement barcode standards at the unit packaging level (no easy feat for Uniject single dose vaccine vials, for example)
  • Getting these standards incorporated in unit labels and procurement specifications (especially at the country level)
  • Getting national drug authorities’ approvals for packaging/label changes without significant cost to manufacturers

And the really big ones:

  • Changing HCW behaviors so that the new business processes required by the technology are used routinely, and
  • Providing user support, and maintaining and replacing the point of care hardware and software in thousands of hard-to-reach areas.”

(Chris Wright, Ethiopia)

“The mobile phone revolution has now reached at least 95% of health facilities in Africa, with at least a basic data connectivity. It is often still 2G, so fairly slow, but it works. Small solar panels take care of electricity needs. There is absolutely no reason why we as professionals cannot get connected.

Low cost smartphones and data modems are a great tool! The only thing stopping us is our own lack of imagination and initiative.”

(Dr. Harry Jeene, Kenya)

“In Sudan, specifically in West Darfur, we implemented a pilot project using a paperless health center. Where the pharmacy is linked to the doctors’ clinic; they can select medicine from the list available and prescribe. This was found to reduce “Not available” signs, because many times when they found that Diclofenac for instance is not available in the pharmacy stock they can prescribe the alternative. Moreover, the pharmacy was linked directly to the district warehouse, where the supply team can check frequently the stock level of each individual items and then supply the pharmacy with the suitable quantities proposed according to the consumption proposed by the system. We are looking forward to expand this project but the challenging step is the training on how to use computers, we have to train staff.”

(Mohammad Musa, Sudan)

“WMS for inventory management is implemented at Federal, Provincial and District EPI (Expanded Program on Immunization) stores for real time tracking of vaccines flow from Federal to last mile. This system enabled users to track batches of all antigens moved from federal to provincial to district and to union council (UC)/EPI centres level. The information is visible to all authorized users for real time access of the information not only tracking but also stock situation, MOS, consumption and cold chain inventory and assets at all tiers of supply chains. The implementation of the system was a challenge but with full ownership of Government of Pakistan enabled us to implement it and more than 3,000 EPI centres from 54 districts are reporting into the system since January 2014 and reporting rate is getting better.”

(Saif ur Rab, Pakistan)

Real Time Tracking and Tracing of Health Commodities