SMS Reporting System for Logistics

[Mike Frost]

Hello,

I work with JSI, and wanted to share some of the basics about cStock, a mobile logistics information system that we've had a lot of success with in Malawi. 

Challenges:

• Accordingly to a 2005 UNICEF study one out of every eight children in Malawi will not live past their fifth birthday.
• 80% of the 13 million Malawians live in rural areas making delivering health services challenging especially in remote parts with no roads.
• Community health workers, called health surveillance assistants or HSAs, have been a way to improve access, especially to women and children.
• HSAs live in the villages with the community and are available during the day and night for mothers to bring their sick children to be treated quickly. These children previously died from common diseases such as diarrhea, pneumonia and malaria which are easily treated if the medicines are available.  
• HSAs also provide family planning products to women in the community providing access to contraceptives
• If HSAs run out of medicines, however, these children are deprived of lifesaving medicines and often their sickness will get worse and more complicated resulting in death.
• The key to keep these children alive past their fifth birthday is to keep the HSAs well stocked with medicines—that’s crucial.
• cStock focuses on making sure HSAs always have the supplies and medicines they need to treat children.
• Challenge is reaching the last mile. HSAs focus on saving children’s lives by treating the common diseases of childhood and providing family planning.

 One Solution:

• With funding from BMGF on the Supply Chains for Community Case Management Project (SC4CCM), JSI worked with Dimagi to create and implement an SMS reporting and resupply system where the goal is to ensure that HSAs always have the medicines their villagers need.
• The system is called cStock because it allows district and central level staff to “see” what’s happening in terms of the stock levels at the community level. Prior to cStock, products were sent out, but it was unknown as to whether there was enough.
• In this system, HSAs communicate about the drugs they need using SMS, send a simple formatted message indicating their current inventory of each product. The system automatically calculates the quantity the HSA needs. The database sends those re-supply quantities in a text message to the health center closest to the HSA. The health center fills the order, putting all of the products in a box for the HSA to pick up. The health center sends a text message to the HSA, notifying him that his order is ready to pick up.
• As everyone in the Ministry is committed to reducing childhood mortality and achieving their MDGs, the visibility into stock levels at the HSA level has created a common goal to address drug shortages and ensure that the health centers have the medicines they need to resupply the HSAs. We have seen districts and central level staff starting to prioritize these medicines and find ways to make sure they are available.
• Advantages: HSA doesn’t make needless trips to the health center, erroneously thinking their order is ready when it’s not. The health center can fulfill the order at a time that is convenient—possibly when there are few patients waiting in line. Better data is available for forecasting and planning purposes. Stockouts can be addressed as they happen.

Results that we’ve achieved so far:

• cStock started in 2011. Currently being used by 1500+ HSAs, half of the HSAs in Malawi.
• WHO provided additional funding to make this scale-up possible
• Reporting rates are as high as 100% in some districts but consistently average above 80% all districts, compared to 43% at baseline. High reporting rates allow accurate quantities of medicines to be shipped.
• 70% of reports are submitted on time and an average of 79% of the reporting is complete.
• 90% of supervisors at health centers regularly receive SMS messages from cStock
• 5 out of 6 district supervisors reported that they access the dashboard between 1 to 5 times a week
• During recent focus groups HSAs said it was quick and easy and that they prefer it over paper based reporting, in fact they would like all their reports to go through cStock.

  Our plans for moving forward:

• Currently we are working with the MOH and partners to find funding to scale up cStock nationally and have a number of possibilities. Senior Management of the MOH would like to see cStock scaled up and become an integral part of the system. A subcommittee with all stakeholders has been developed around the scale up of cStock. 
• JSI has has success with similar SMS logistics systems in Tanzania, Ghana, and Guatemala. It seems to be a general approach that would work for most countries. 

Challenges/Lessons Learned

 

•  When we first started implementing, we discovered that some HSAs did not know how to send a text message, despite an initial assessment with findings to the contrary. They had a phone but were only accustomed to using voice. This made training slower, so we learned to pair up HSAs with HSAs who had experience and they learned quickly with their peers.
• Sustainability and scalability are very important to us, so we designed the system so that it would work with even the most basic of phones that people already own. However, there were still a few HSAs that did not have phones, and the program does not provide them phones. Nevertheless, many of the HSAs used their allowances from the workshop to buy a phone because they could see that cStock would make their work easier.
• Transferring ownership to the MOH is difficult. Still working on a feasible financial model that will allow the system to continue.

[Jan Flowers]

Thanks Mike. That's really interesting. Is there documentation to read more about the actual workflow and how cStock works?  Is the software available and/or source code available to look at/use?

Jan Flowers

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[Cory Zue]

Hey Jan,

On Wed, May 22, 2013 at 9:50 PM, Jan Flowers <j9.fl...@gmail.com> wrote:

Thanks Mike. That's really interesting. Is there documentation to read more about the actual workflow and how cStock works?  Is the software available and/or source code available to look at/use?

I was one of the Dimagi developers who wrote most of the code. The attached screenshot shows the basic workflow (replace "StockAlert" with "cStock" - this was a very old version of the workflow before the project had a name).

The code is all open source (it's built off an SMS web framework called RapidSMS) and is available here: https://github.com/dimagi/logistics/tree/malawi-dev

Cory