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Title of Abstract

The Hard Road to reliable LMIS: Lessons learned in providing access to accurate
and timely data

Organization:
Name of Organization: Partnership for Supply Chain Management
Location: Arlington, VA

Contact Information:
Name: Michael P. Rodriguez
Title: Management Information Systems Technical Coordinator
Project: Supply Chain Management System
Email address: mrodriguez@pfscm.org

Background: Lack of access to reliable and timely data for forecasting, supply planning and
delivery of life-saving commodities is most often cited as a key impediment to countries ability to
properly support HIV program scale-up and meet access targets. Lack of a comprehensive and
integrated logistics management information system (LMIS) results in stockouts and wastage due to
expiry and hinders forecasting and planning which can then lead to expensive emergency
procurements or overstocks. This can have disastrous consequences for patients and unnecessarily
increases supply chain costs.

Under the Supply Chain Management System (SCMS), work is being done in seventeen countries to
strengthen or establish secure, reliable, cost-effective and sustainable supply chains capable of
meeting the care and treatment needs of people living with and affected by HIV and AIDS. In
coordination with in-country and international partners, SCMS assists programs to enhance their
supply-chain capacity; ensure that accurate supply-chain information is collected, shared and utilized
for decision making; and provide high quality, affordable, health care products to those who need
them.(179)

Objective:
Creation and implementation of high quality LMIS is an essential innovation that can make or break
the sustainability of strong ARV treatment programs. Countries with reliable LMIS have greater
visibility into the public health supply chain so that they may consistently collect, report and
aggregate data to enable sound decision-making for ordering, re-supply and forecasting to reliably
meet the needs of patients. In cases where none exist, SCMS is working to establish reliable LMIS.
In all cases, the objective is to improve the availability of reliable information for informed decision
making. (90)

Methods:
In Zambia, SCMS broadened the stakeholder groups involved in the LMIS development process to
include all those who contribute to health system strengthening; government, civil society and the
private sector to avoid developing parallel systems. SCMS also initiated an iterative process of
standardizing laboratory equipment across the country so that a more streamlined list of reagents
and consumables could be procured. At the beginning of SCMSs work in Zambia, no LMIS for
laboratory supplies existed. Working through Laboratory Technical Working Groups that include
the Zambian Ministry of Health and CDC, SCMS facilitated the design of a new, integrated system
that was rolled out to all regions in the country. Health facilities report using paper forms on a
monthly basis to the central Logistics Management Unit, which calculates refills using a
computerized system. These changes helped reduce laboratory commodity stockouts of 185 priority
commodities from up to 70% of items in 2007 to less than 3% at the end of 2008.

As PEPFAR was scaling up in Ethiopia, there were multiple USAID funded projects tasked with
building distinct electronic information systems to support aspects of the LMIS.
USAID|DELIVER developed an electronic system, Health Commodity Management Information
System (HCMIS), to support inventory management and LMIS reporting at large, high burden
facilities. SCMS and USAID|DELIVER customized HCMIS to perform inventory and warehouse
management for the regional hubs for distribution of pharmaceutical supplies. Strengthening
Pharmaceutical Systems (SPS) supported health facilities in tracking drugs dispensed with its
Electronic Dispensing Tool (EDT). SCMS worked with these projects to consolidate data into a
centralized system that allows for multiple modes of data capture: web-based, mobile phone based
and offline computers. The Pharmaceutical Information Management System (PIMS) improved
communication across projects and reporting levels, reporting rates increased from 70% of facilities
to more than 99 % and reduced reporting times from 1-2 months to within 3-5 days of the reporting
period closing. The project faces further challenges, however, as the Ethiopian telecommunications
infrastructure has not proven robust enough to support consistent mobile phone reporting. (360)

Findings:
Across its many LMIS efforts, a number of lessons learned have emerged:
Leadership in system redesign by host governments and broad stakeholder involvement
across the system is vital to ownership and sustainability.
Streamlining and standardizing commodities procured through the supply chain can
drastically rationalize inventory management and increase visibility.
Cross project communications within countries is imperative to avoid overlap and/or
redundant LMIS development efforts.
A software/system development life cycle (SDLC) approach ensures that process flows and
business requirements are fully documented and understood before focusing on building
electronic LMIS. (51)

Conclusion:
There are as many approaches to building sustainable and effective LMIS as there are countries
being supported. No single system will work for every country, but applying a consistent approach
to building LMIS that takes into consideration the local context and engages stakeholders at multiple
levels in the data flow system improves the probability of sustainability. (57)