Promoting access and delivery of health technologies through the South-South exchange of innovative technology, knowledge and solutions
Immunization is a life-saving and cost-effective intervention against many communicable diseases, saving up to three million lives globally every year. However, millions of children still lack access to vaccines in low- and middle-income countries, despite recent overall improvements in their health systems.
This is certainly an issue that concerns Indonesia, where only 58 percent of children have completed their basic course of immunization. With over 76 million infants, children and women of reproductive age spread across 6,000 islands in need of routine vaccination, Indonesia faces a steep challenge in ensuring effective implementation of its immunization programme.
The immunization gap in Indonesia is exacerbated by the inefficient distribution of vaccines across the supply chain. The weak inventory and data management system, combined with the relatively short shelf-life, cold storage needs and long supply chain of vaccines have contributed to significant inefficiencies in the supply chain.
Addressing these challenges will accelerate Indonesia’s progress towards achieving Sustainable Development Goal (SDG) Targets 3.3 (Combating the spread of communicable diseases) and 3.8 (Promoting equitable and timely access to life-saving vaccines and universal health coverage).
Towards a Solution
Eager to improve the immunization coverage in Indonesia, the Ministry of Health (MOH) discovered an innovative digital solution developed by the Indian Ministry of Health and Family Welfare (MOHFW), with support from the United Nations Development Programme (UNDP) India and Gavi, the Vaccine Alliance.
The Electronic Vaccine Intelligence Network (eVIN) is a digital mobile and web-based system that enables real-time visibility of the vaccine supply chain and cold-chain logistics. It provides end-to-end tracking of vaccine inventory, automated data analytics and instant alerts to support quick and effective decision-making and action.
Since it was first introduced in October 2015, the impact of eVIN on India’s Universal Immunization Programme (UIP) has been immense. Vaccine stock-outs and wastage are now significantly lower while availability and coverage have improved. An independent economic analysis estimated that eVIN provided a three-fold return on investment for the UIP. By the end of 2020, eVIN will be operational in all 28,000 health facilities across the country, reaching 156 million beneficiaries.
Real-time visibility on vaccine stocks and movements through eVIN has helped ensure that vaccines are stocked in the right quantities and are available in time. Photo: UNDP India.
The unique features of eVIN and the significant outcomes achieved in India quickly gained widespread attention across the Asia-Pacific region and beyond. Given such strong interest, UNDP established a knowledge hub in India to promote South-South engagement and cooperation on eVIN and other aspects of digital health and supply chain management. Following an initial exchange in early 2017 where delegations from several countries visited India to vet the eVIN technology and better understand its enormous benefits, the Indonesia Ministry of Heath registered its strong interest in adapting the system. As such, UNDP was tasked with leveraging its expertise and experience in managing the deployment of eVIN in India to facilitate the transfer of technology, knowledge and experience to Indonesia.
To facilitate this technical transfer, the Ministry of Health and Family Welfare (MOHFW) and UNDP India hosted a high-level delegation from Indonesian Ministry of Health on a study tour to directly observe the operationalization of eVIN at vaccine storage points and health centres, and gain valuable insights into its usability and adoptability. The study tour allowed for extensive dialogue between the Indonesian delegates, senior members of India’s UIP and policymakers from MOHFW. These discussions offered in-depth understanding of good practices and appropriate policies, as well as the feasibility of, and strategic approach to, adapting eVIN in Indonesia.
This study tour not only provided a rich opportunity for the Indonesian Ministry of Health to learn about the experience and lessons from India, but also for India’s UIP to showcase its ground-breaking digital innovation and success story.
Following the study tour, the Indonesian Ministry of Health began piloting eVIN in 54 health centres across two districts (Bogor and Tangerang Selatan). UNDP in India and Indonesia worked together to guide the initial assessment of the vaccine supply chain and digital infrastructure, and the development of costed strategic and operational plans for the pilot districts. One important focus was the customization of the eVIN technology and adaptation of relevant Standard Operating Procedures and training materials to the local context. To reflect these technical modifications and to promote country ownership, the Indonesian version of the eVIN system was rebranded as ‘SMILE’ (Sistem Monitoring Imunisasi Logistik secara Elektronik).
Photos: UNDP Indonesia.
UNDP also helped deliver district-level training of health workers and managers from the national immunization programme, followed by ongoing mentoring and technical support as the system is rolled out. Additional support for South-South technical exchanges and the adaptation of available resources and lessons were provided by the Access and Delivery Partnership, a global initiative led by UNDP, which contributed to the effective roll-out of SMILE in Indonesia.
The introduction of SMILE has made the vaccine supply chain more efficient and coordinated in handling 1.4 million doses of vaccines and reaching over 850,000 beneficiaries. Within the first 12 months of implementation, vaccine stockouts were reduced by 55 percent and the ‘vaccine availability index’ reached 99 percent. The level of over-stocking and stock wastage dropped by over 50 percent and 90 percent, respectively, while the lag in stock replenishment time went from 25 days to less than three days.
The SMILE application was reported to have a high level of user satisfaction and acceptance among health workers, which resulted in better productivity and performance. The higher degree of control over the management of the vaccine supply chain has instilled a significant level of commitment, confidence and pride among health workers in carrying out their duties.
Photos: UNDP Indonesia.
With the success of the pilot, the Indonesian Ministry of Health made the decision to expand SMILE to a further 600 health centres in 23 districts, reaching nearly seven million beneficiaries. The scale up is taking place in 2020 with implementation support from UNDP Indonesia, and co-financing from the Government of Indonesia and Gavi, the Vaccine Alliance. In addition, due to the system’s high level of cost-effectiveness, end-user satisfaction, adaptability and interoperability with the current health system infrastructure, it can be quickly brought to scale, further contributing to the sustainable utilization and expansion of the system.
The South-South engagement, exchange and cooperation between stakeholders in India and Indonesia have been critical in amplifying the health impact of an innovative digital solution. UNDP will continue to leverage its extensive network of global initiatives, such as the Digital Health and Supply Chain Knowledge Hub in India and the Access and Delivery Partnership, to facilitate South-South sharing of rich experiences and knowhow, and provide ongoing capacity building, mentorship and guidance to improve health outcomes and achieve the SDGs.
Cover photo by UNDP India.
This article was originally published in UN Office for South-South Cooperation (2020). Good Practices in South-South and Triangular Cooperation for Sustainable Development — Volume 3.