Unveiling the Economic Value of SMILE, Indonesia’s Digital Solution for Vaccine Supply Chain System

In West Sumatra, Indonesia, about 12,700 kilometres from the capital city Jakarta, lies the bustling Bungus community health centre. Here, the daily morning practice of preparing for routine immunizations unfolds, with a purpose that extends beyond the walls of the health facility. Armed with the SMILE (Sistem Monitoring Imunisasi Logistik secara Elektronik) app, pharmacist Sri Hartati checks the stock and quality of vaccines stored in the cold storage.

SMILE is an innovative digital solution to strengthen the immunization supply chain system developed through a partnership between UNDP, the Indonesian Ministry of Health, the Government of Japan and Gavi, the Vaccine Alliance. Since 2018, the system has proven to be an indispensable tool, providing real-time, reliable data on vaccine stocks, and a lifeline in the fight against preventable diseases. The system is helping to ensure equitable access to life-saving vaccines for even the most marginalized communities scattered across the vast Indonesian archipelago.

Today, SMILE is being implemented across 34 provinces, in 514 districts. Over 10,000 community health centres and 3,000 public hospitals are using SMILE for routine immunization, reaching at least 15 million children and 5 million pregnant women per year.

Beyond its role in safeguarding lives, SMILE also improves economic efficiency in the distribution of vaccines. An economic analysis of SMILE was conducted to measure the benefits that can be generated from digitalizing the logistics chain of the immunization program, as well as providing key lessons that will inform program implementation. The study was conducted by the Directorate of Immunization Management, Ministry of Health and UNDP, together with SurveyMeter Research Institute, with technical guidance from health economic experts at the Health Intervention and Technology Assessment Program (HITAP) Thailand, and the University of Indonesia.

Eight community health centres located in seven districts/cities across seven provinces of Indonesia were part of the research. Researchers compared the data collected six months prior to SMILE implementation to data implemented six months after SMILE implementation.

Among the most significant findings SMILE was found to deliver a substantial return on investment value of 2.77 and a benefit-cost ratio (BCR) of 3.77. In practical terms, this signifies that for every Indonesian Rupiah (IDR) invested in the SMILE program, there is a return of IDR 2.77 in addition to the initial investment. The BCR of 3.77 indicates that the benefits of SMILE far outweigh the costs, making this initiative cost-effective.

The study findings showed that Internet of Things-based remote temperature loggers installed in vaccine storage units and connected to SMILE, could potentially prevent the monthly loss from temperature excursion valued at as much as IDR 457 million (approximately US$32,000) per community health centre. The loggers help ensure that vaccines are stored at the correct temperatures, between 2°C and 8°C, preventing vaccine degradation. Nearly 5,000 health facilities have installed the temperature loggers, with support from Gavi, the Vaccine Alliance.

The study also revealed that since the introduction of SMILE, there has been a 70 percent decrease in the occurrence of vaccine stock-out events for routine immunization. Additionally, SMILE has facilitated the distribution of 457 million doses of COVID-19 vaccines to over 12,000 health facilities nationwide.

SMILE's artificial intelligence and big data analytics help to enable swift decision-making and prioritization of vulnerable populations. This reflects the strong commitment to bolster immunization coverage and ensure the accuracy and reliability of information on the vaccination process.

Overall, the study concluded that SMILE is a valuable tool for enhancing vaccine management in Indonesia. The system has proven effective in minimizing vaccine stockouts and wastage, thereby improving the quality of Indonesia's immunization program.

Looking ahead, the results gained from this study open doors to explore additional priority policy questions in digital health and immunization programs. By leveraging these findings, we can foster a collaborative dialogue to address emerging opportunities and challenges, steering the trajectory of public health interventions towards a more resilient future that leaves no one behind. The gap in equal access to quality health services for hundreds of millions of people living in Indonesia is poised to become a thing of the past.

The full report can be accessed via this link: https://www.undp.org/indonesia/publications/economic-analysis-smile-immunization-program

This study was supported by the Access and Delivery Partnership (ADP), a global project led by UNDP and implemented in collaboration with the WHO, TDR (Special Programme for Research and Training in Tropical Diseases) and PATH, with funding from the Government of Japan. Learn more at https://adphealth.org/

About Gavi, the Vaccine Alliance 

Gavi, the Vaccine Alliance is a public-private partnership that helps vaccinate more than half the world’s children against some of the world’s deadliest diseases. The Vaccine Alliance brings together developing country and donor governments, the World Health Organization, UNICEF, the World Bank, the vaccine industry, technical agencies, civil society, the Bill & Melinda Gates Foundation and other private sector partners. Learn more at https://www.gavi.org/

Further information: 

Vidia Darmawi, National Project Manager for SMILE at UNDP Indonesia, vidia@undp.org

This article was originally published in https://www.undp.org/indonesia/