Fp-lmis Training Manual

[Leysan Torri]

TheFundamentals of Laparoscopic Surgery TM (FLS) program is comprised of two components: education and assessment. The comprehensive web-based education module includes 13 chapters covering everything from equipment and patient prep to post-operative care. Also included in the didactic material are videos detailing the hands-on skills training component. The FLS assessment tool is designed to evaluate the learners understanding of the physiology, fundamental knowledge, case/problem management skills, manual dexterity, and technical skills required in basic laparoscopic surgery.

As a non-procedure specific program, our goal is to provide all surgical residents, fellows and practicing physicians an opportunity to learn the fundamentals of laparoscopic surgery in a consistent, scientifically accepted format and to test cognitive, surgical decision making, and technical skills, all with the goal of improving the quality of patient care. The FLS program content is a joint educational offering of SAGES and American College of Surgeons (ACS) and has been endorsed by the American Board of Surgery (ABS), the Canadian Association of General Surgeons (CAGS) and the American Board of Obstetrics and Gynecology (ABOG).

1USAID Global Health Supply Chain Program, Procurement and Supply Management, National Science and Technology Park, Islamabad, Pakistan (Correspondence to: Muhammad Tariq: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).

Background: Pakistan and USAID have invested in improving the contraceptive supply chain data and commodity security. In 2011, the first digital contraceptive logistics management information system (cLMIS) was launched, enabling supply chain data visibility from the federal level to health facilities. The system has built-in modules on forecasting and supply planning, inventory management, consumption reporting, business intelligence tools, automatic email and SMS alerts. Using these features, policy-makers and health managers annually forecast needs, and procure contraceptives accordingly.

Aims: The objective of this research was to understand the existing technological platforms for family planning (FP) supply chain data visibility and the potential impact on contraceptive commodity security.

Methods: The authors reviewed available published and grey literature papers on contraceptives and supplies in Pakistan. We extracted data from the cLMIS, evaluated indicators including reporting compliance, reported stock-out rates, and contraceptive performance. The analysis was validated by reviewing supply chain and FP indicators, such as average monthly consumption, months of stock, and couple years of protection.

Results: The cLMIS has resulted in improved distribution, early warning and accountability at the lowest tiers in the FP supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018.

Conclusion: Contraceptive supply chain has seen significant growth over the past decade to meet expanding reproductive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock availability at public sector facilities.

In 2010, provincial departments of population welfare were moved to the administrative control of the provinces and became administratively independent from the Ministry of Population and Welfare. This administrative change did not create significant improvement in health systems (9); even with support from donors and nongovernmental organizations, supply chain systems remained ad hoc and fragile. A 2014 qualitative study showed frequent stock-outs and interrupted supplies decreasing access to FP (6). Requisitioning contraceptives from different departments/stakeholders, poor supply mechanisms, lack of transportation financing, inadequate planning, procurement delays and the lack of a monitoring and supervision framework compounded the challenges (6). Before 2011, the system was inadequate owing to the lack of a standardized logistics management information system (LMIS) for FP products (10).

Prior to the implementation of the contraceptive logistics management information system (cLMIS) in Pakistan, the reported clients, via service delivery point data and observed by surveys, showed major differences. The contraceptive performance reports published by the Pakistan Bureau of Statistics depended on the collation of the manual records available in the warehouse, and even then showed some inconsistencies (Tables 1,2).

In July 2011, during the first phase of implementation, 19 districts (out of 143 total) across Pakistan were equipped with the system. Staff were trained, and pilot testing carried out to verify that the new system would improve data visibility, enabling effective stock monitoring. By 2012, it had been scaled up nationally and was used in all 143 districts. With USAID support, around 1000 government staff in provincial health and population welfare departments received training on how to use the cLMIS (17).

The authors reviewed papers on contraceptive use and logistics, both published and grey literature, relating to Pakistan as well as the contraceptives performance reports compiled by the Pakistan Bureau of Statistics and the Pakistan Demographic and Health Surveys (6,8,18). In addition, data was extracted from the cLMIS, focusing on such indicators as reporting rate and stock availability ratios. The data extracted from cLMIS included indicators on data reporting compliance, reported stock-out trends and contraceptive performance (Figure 1).

Web-based end-to-end dashboards made the cLMIS data for the entire supply chain visible to government decision-makers, including but not limited to the health secretariat and federal and provincial health ministries. These powerful analytics inform the relevant authorities to take timely actions for stock replenishments at district and health facility levels. One key example would be the FP executive dashboard, which informs the decision-makers at the provincial and district levels where service delivery point stocks have gone below the agreed-upon levels, posing a risk of stock-out. The system also automatically generates stockout emails and SMS alerts, enabling relevant officials to take timely decisions.

The FP executive dashboard was developed to provide an overview of stock sufficiency for FP commodities in all 4 provinces, relevant districts and service delivery points/health facilities. In each province, the health and population welfare departments are the main consumers of FP commodities, and in some provinces, such as Sindh, both departments are procuring jointly with storage at the Central Warehouse and Supplies in Karachi. Thus, the dashboard not only provides a real-time stock situation at the Central Warehouse & Supplies but also the pipeline for each product, enabling users to observe the stock situation for a particular commodity at the service delivery point level (20).

It is worth noting that data reporting in the districts and health facilities is compiled on a monthly basis. Consequently, the stock data for districts and health facilities will be displayed in the upcoming month, i.e. data related to March will be displayed in April after data entry has been completed. By requiring that data for a given month be reported before the 10th of the upcoming month, data visibility is greatly improved. This monthly reporting also accurately calculates reordering dates such that stock sufficiency levels are maintained, minimizing the possibility of future stock-outs.

The stock-out rate is defined as the number of service delivery points that, at any point, in a defined period (e.g. the past 3, 6 or 12 months), experience a stock-out of a specific FP tracer product that the service delivery point is expected to provide. The web-based end-to-end dashboards display the months of stock for each product using different colours to identify the level of severity with respect to replenishing the stock. This provides users with intelligence for when and how much a particular product needs to be ordered in the future to maintain the desired maximum stock levels.

The paper-based reporting system was automated, leading to better maintained and more accurate records and the removal of duplication of efforts. Political ownership and support by senior leadership for cLMIS helped to achieve timely data reporting and ensure data quality, leading to effective decision-making (24). The provincial authorities issued notifications to the districts for reporting compliance, which enabled timely visibility of data (25).

Another challenge is sustainability. There is still no health information and communication policy which could serve as a guideline for digitizing the health sector, avoiding duplication of efforts and leveraging technology for evidence-informed decision-making (28). There also remains a lack of trained human resources (29). Management issues like calibrating stock (to avoid stock-outs or overstocking) as well as lack of communication and interdepartmental coordination also complicate efforts (19,30). Other issues include inconsistencies in reporting meaning the system is unable to identify exact demand (6). Finally, there are challenges around financing for delivering FP products from the district warehouses to the health facilities. Strengthening supply chains to meet the growing demand for FP will require systems diagnostics, supply chain redesign or adjustment, strategically located storage and distribution systems, adequate staffing and training, and better information about inventory and financing (31). To help address these challenges, there is a need to bring all stakeholders together to have and use a single platform for an integrated health information system where services, surveillance, demographic and logistic data streams intersect in addition to health information and communication policy.

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