PRAVAAH

William J Clinton Foundation

PRAVAAH

PRAVAAH is an intervention designed to ensure antibiotic access in public facilities by preventing and mitigating stock control challenges

Bhopal, Madhya Pradesh, India

IND

Hybrid of for-profit and nonprofit

Our solution addresses the critical challenge of ensuring optimal antibiotic availability at community-level public health facilities. Drug availability especially antibiotics at public health facilities is critical in India, which often report stock-outs of essential medicines lasting up to 4–14 weeks (https://pmc.ncbi.nlm.nih.gov/articles/PMC11174260/). Stock outs of essential antibiotics, required for critical needs often push patients to seek them in private sector. Antibiotic procurement and distribution are currently reliant on push mechanisms and are uninformed by local AMR patterns— causing mismatches between antibiotic supply and clinical needs. This is often made complicated by the fact that, patients trust privately available medicines in terms of quality more than those disbursed at public facilities. Stock-out mitigation remains ad-hoc, and standardized procedures for effectively addressing shortages are unavailable(https://doi.org/10.1016/j.cmi.2024.09.023). This places additional burden on healthcare staff, particularly pharmacists, who manually manage inventory amid significant workload pressures. As a result, stock visibility across supply chain remains fragmented and inaccurate(https://tinyurl.com/3bypa8u8), contributing to reactive rather than proactive stock management. Such inefficiencies lead to stockout of antibiotics, leading to significant out-of-pocket expenditures for patients thus exacerbating health inequities.

PRedictive Analytics and supply chain Visibility to enable Antibiotic Access for Health (PRAVAAH - meaning 'flow' in Sanskrit), is a multi-component solution designed to ensure antibiotic access in public health facilities through state level support in Madhya Pradesh, along focused implementation in one district. PRAVAAH has 6 core components: • Predictive modelling using machine learning to forecast stockouts at community health facilities, based on historical supply and consumption data, antibiotic hierarchy and interchangeability mapping, and other demand predictors such as disease incidence. • Development of community-level estimates of ideal antibiotic consumption based on AMR patterns (informed by antibiograms generated at Ibhar’s network of community level labs), compared to those based on WHO’s AWaRe classification(https://tinyurl.com/585n6wc2) and actual consumption, to inform procurement and distribution. In case of stockouts, antibiograms will support clinician decision making on alternate antibiotics. • Optimized inventory management and SOP development to enable pre-emptive stock redistribution and prevent shortages. • Prepaid digital voucher reimbursements through e-RUPI(https://www.npci.org.in/what-we-do/e-rupi/product-overview), allowing public-sector patients to purchase antibiotics from private pharmacies during stockouts. • Barcode-enabled inventory management integrated with e-Aushadhi (India’s public health LMIS), to enable real-time visibility. • A dispensation monitoring module for pharmacies.

PRAVAAH primarily serves underserved communities in Madhya Pradesh who often face prolonged stockouts of antibiotics at public health facilities. In such scenarios, patients are either left untreated or forced to seek private care, incurring high out-of-pocket expenditures and opportunity costs. PRAVAAH ensures timely access to effective antibiotics—reducing treatment delays, financial hardship, and the risk of complications from delays in treating infections. District and state-level program managers benefit from predictive insights into stockouts and actionable redistribution protocols. The tool would also enable the use of first-line/"Access" antibiotics which are relatively cheaper and thus save health system costs. Manufacturers and suppliers also benefit from insights into AMR-informed demand trends. This helps them align production to actual community needs over the long term. Pharmacists and storekeepers - who currently rely on manual processes to manage inventory would gain through this solution in reducing administrative burden and errors. Overall, PRAVAAH has the potential to enhance system responsiveness and equity by putting the right antibiotics in the right hands at the right time.