Immunization supply chain dashboards

Having the right information at the right time is critical to making

decisions about where and when to deliver immunization supplies.
Dashboards showing information such as where vaccines are needed,
the rate of stock consumption and whether vaccines are adequately
stored provide a way for health workers to identify problems and
determine possible corrective actions to take.

In summary, dashboards are beneficial because they can:

identify important areas for performance improvement

be used for advocacy to leadership

support a results-driven organizational culture

communicate progress and success at multiple levels

be used to set goals for both team and processes

support users and encourage feedback and feed-forward

identify exceptions and signal alerts

provide a common platform for interaction and data analysis

identify the effect of interventions on performance

Depending on the speed of execution necessary for any given

intervention, dashboards can be used to prompt three types of action:
operational (urgent), tactical (medium-term) and strategic (long-term)
action.

Table 1: Dashboards and action priority: Example for cold chain

equipment functioning
Operational Tactical decisions Strategic decisions
decisions (medium-term ) (long-term )
(urgent )
Purpos Ensure working Improve trends of Improve the
e status of functional performance,
equipment equipment appropriateness
and quality of cold
chain equipment
Time Day or week Upcoming quarter Annual planning
frame and continuous cycle/ next multi-
year plan
Action Repair broken cold Change Revise cold chain
chain equipment at maintenance equipment
 health facility A schedule and focus specifications for
on preventive national
maintenance procurement

Operational actions address immediate programme needs, while tactical

and strategic actions contribute to large-scale improvement of the
immunization supply chain over a broader time span. Note that
operational actions most often depend on the existence of processes and
technology sophisticated enough to produce nearly real-time data, which
may not be available in all country contexts. Accordingly, much of this
guidance will focus on tactical
and strategic actions based
on dashboards.

The use of dashboards

requires a distinct workflow,
Data collection
which can be visualized in the
following manner:
Improvement plan In this generic example,
Data reporting health workers first collect
and then report the data to
the next level, where paper or
Visualized indicators in dashboard Action electronic dashboards
streamline, or crunch, data
from what could be an
overwhelming number of data
points into indicator
Performance and indicator Root cause
alarms analysis
visualizations that are easily
interpretable. The specific
indicators used in the
dashboard can clearly
Feedback and supervision by manager
indicate areas that are
performing well or performing
poorly and, if the dashboard is
Figure 1: Dashboard workflow electronic, even provide
alarms. At this point, managers can
provide health workers with the feedback and supervision necessary to
address the problems immediately, but they can also initiate a root cause
analysis to gain further insight into the reasons for the poor performance.
From the supervision and root cause analysis, an adequate improvement
plan for long-term actions can be drafted, and acting on it will ultimately
improve both the indicator performance on the dashboard and the supply
chain performance in general.

It should be stressed that although the dashboard can point out a

problem, it often does not indicate its cause, meaning that further analysis
is required to identify the right corrective action.
As an example, a root cause analysis of a high rate of temperature alarms
could result in the following possible root causes: cold chain equipment is
old, frequent power failures in the region and problems of human error or
thermometer accuracy. Once the exact cause triggering the high alarm
rate is found, the appropriate solution to the problem can be
implemented.

The following country case study describes the above process in an actual
setting.

In 2013, a new, electronic, approach to supply chain management was

implemented in Niassa Province, the Sistema Dedicado de Logstica
(Dedicated Logistics System), aiming to increase on-time deliveries to 80
per cent and cold chain equipment uptime to above 80 per cent. Some of
the challenges encountered in pursuing these goals, the root causes of
poor performance and actions taken to resolve them are highlighted
below:

Problem identified: Distribution delays

Root cause: Monthly vehicle maintenance was scheduled too close to
each months delivery date, causing delays when maintenance was not
finished on time.
Action: Vehicle maintenance was scheduled earlier each month to ensure
that each vehicle was ready for each delivery round.

Problem identified: Low cold chain equipment uptime

Root cause: Lack of financial support to keep a cold chain technician on
the delivery team lowered cold chain equipment uptime to the level it was
before the technician joined the team.
Action: The dashboard was used to advocate for more financial resources
to keep the technician on the delivery team.
Name Full Stock Availability
Descripti Percentage of storage points with full availability of all or a
on selected set of tracer vaccines and immunization supplies
over a resupply period. Full availability is defined as no
stock-out in the store or health facility at any point during
the time period.
Purpose Measures the availability of immunization products.
Availability of vaccines and immunization supplies is
important to reach immunization programme targets.

The following questions can be answered by monitoring the

performance of this indicator:
Are certain facilities frequently at risk of stock-outs?
What is the full availability percentage by district or
region?
Does low availability in the national or resupply store
affect availability at lower levels?
Is full availability lower than expected in certain
health facilities or regions?
Performa Availability
nce
objective
Domain Stock management
Full % of health facilities with full availability
indicator % of districts with full availability
name(s) % of districts with at least x% of facilities with full
stock availability
Dashboa This indicator is recommended in dashboards used by sub-
rd use national and national managers.
level
Precondi This indicator can be implemented in any context, as it
tions requires only observation of zero stock balance during the
resupply period.
System Relevant in all types of logistic systems.
design
Data Product stock-outs in stores and health facilities
needed OR: closing balances at the end of the resupply period
in stores and health facilities
Data Stock cards/ledgers
sources Physical inventory/physical stock counts
Stock-out reports from health facilities
Logistics management information system (LMIS)
Data Where necessary, full availability can be determined for a
collectio basket of tracer indicator products representing the
n availability of immunization supplies.
method
Calculati Full stock availability = resupply periods without stock-out
on of any (tracer) vaccine or immunization supplies

At sub-national and national level, the indicator is

aggregated as % of health facilities or % of districts with full
stock availability. The calculation for a sub-national region
is:

% health facilities with full stock availability = (# health

facilities with full availability ofRed
all = Full stock
(tracer) availability < 80%
immunization
products)/(total number of health of HFfacilities in sub-national
District District
District Green = Full stock availability >