Digital Inventory Management Tool (DIM-T)

The Indian Public Health System has been plagued by an inefficient supply chain contributing to unavailability, wastage, and expiration of essential drugs at the primary health care level. The situation continues to perpetuate despite the introduction of the Drugs and Vaccine Distribution Management System (DVDMS) up to the level of primary health care facilities, a web-based supply chain management system that deals with the purchase, inventory management & distribution of various drugs, sutures and surgical items at all government health facilities and Drug Distribution Counters (DDCs) within the State/Union Territories. DVDMS was supposed to alleviate issues of poor logistics, delays in facilities raising indentation (technical term used to generating the demand for drugs and consumable stock) and payment to streamline the availability of drugs and vaccines and provide real time tracking of stocks at health facilities. However, a study conducted in India in 2021 showed that only about 52% of a group of essential medicines were available in more than 80% of primary health facilities (Meena, 2021). Added to this, reports suggest erratic and irrational indentation of drugs resulting in large number of expired medicines on one hand and scarce availability of drugs on the other (PTI, 2022). Pharmacists, deployed at primary healthcare facilities and warehouses are mandated to utilize the platform for inventory management. However, there is sub optimal use of the tool because of lack of knowledge and capacity of the pharmacists, poor user-friendliness of the platform, poor monitoring of the DVDMS system, and inability of the staff at facility, and by the users of platform. The poor design of the platform and lack of capacity of the users leads to poor data quality. Also, as there is lack of insight by the platform to support the decision-making by the users, the stock requirement raised by facilities is largely based on assumptions (rather than data driven), adding to the problem of untimely, irrational, and erratic demands for drugs. Monitoring of DVDMS is inefficient and irregular at the district level. The lack of data validation and verification of the stock requirements and usage lead to misappropriation of stocks.  It has also been reported that the DVDMS interface is not user-friendly or intuitive and does not allow visibility of available stocks of other facilities.

Only a limited number of primary health care centers are regularly using DVDMS for inventory management. In addition to this operationalization of DVDMS is still lacking at the sub-centers where the inventory management is completely a manual process (India’s primary healthcare systems is divided into two tiers 1. Sub-centers at the group of villages provides limited primary healthcare services focused mostly on basic screening and diagnostics along with community outreach 2. Primary health care center at the level of group of sub-centers providing a wider range of primary health care services).

If utilized optimally, DVDMS could be a game changer for the supply chain domain of the Indian Primary Health Care system.

PATH is currently working to build a model district in Satara, Maharashtra, India by providing technical and implementation assistance to the government to devise sustainable and scalable solutions for improving the accessibility and quality of comprehensive primary health care services. This also includes strengthening the supply chain of drugs in the district to improve the availability of drugs at facilities through following efforts:

PATH is supporting capacity building efforts including training, mentoring, refreshers, and onsite technical assistance to enhance knowledge, awareness and understanding of inventory management including use of DVDMS tool to address the issues related to data quality and monitoring the uptake of the platform.

PATH would develop a prototype, digital inventory management tool (DIM-T) building upon the existing DVDMS platforms which would address multiple challenges including poor data quality on the DVDMS system, irrational demands raised for indentation of drugs, unwarranted expiration of drugs and lack of visibility of drug stocks at nearby facilities. PATH will also support the government in extension of this tool to the level of sub-center.

The DIM-T will have the following salient features:

In the prototype stage, the tool will be MS excel followed by a web version. Based on the pilot learings and result PATH will work with the government authorities for the integration of DIM-T with the DVDMS platform. This will address the sustainability and scalability of the solution since DVDMS is already a government owned and operated tool

Facility Staff will benefit by 1) Increased efficiency of  raising stock requirement as per need ( process of indentation) for the facility staff 2) Enhanced quality of care rendered due to availability of drugs 3) Increased ease of utilizing the DVDMS tool with integration of DIM-T and capacity building (and using data to drive decisions) 4) Greater reliability of the quantities of drugs indented

Warehouse Managers will benefit by 1) Efficient indentation of drugs from State based on dependable data. 2) Improved utilization of storage space 3) Reduced quantity of drugs wasted due to expiration and under utilization

Community will benefit by improved availability of drugs at the facility

At PATH, we believe in leveraging technology and innovative solutions as catalysts to existing health system and infrastructure to strengthen it further, thereby increasing its accessibility, accountability, and affordability. Our effort to build a prototype software for sub centres at the PHC level will help us provide a piloted solution to the State for scale up, and the forecasting tool will further strengthen the existing functions of the DVDMS. The pilot at Satara district will provide insights on the operational aspects of DIM-T and its challenges, which will be critical for us to iterate the design as it may be scaled up across the state and adapted for use in other states as well.

Presently we are working in Satara district on comprehensive primary health care and have a robust set of activities focusing on service delivery, continuum of care, diagnostics, and innovations in point of care accessibility and affordability, quality assurance, and supply chain management. Improving the supply chain including inventory management for healthcare facilities is of importance, givenunavailability of drugs in a major hindrance in enhancing the quality-of-service delivery at these facilities.

Our team has established a strong rapport with the Satara district officials and facility staff, which can be leveraged to pilot the DIM-T prototypes. As we closely know the challenges around the current system and apprehensions about its utilization, the solution developed by us would be based on the strengths and challenges of existing human resource for health.  Now, we are also undertaking a human centered design study to understand the enablers and barriers to primary health care in Satara district, both on the supply and demand side. This would include a segment on supply chain issues and challenges which will further guide our proposed piece of work. 

Our proposed solutions would be piloted under our on-going project in Satara district, Maharashtra. Apart from the financial support to the pilot, being a part of MIT challenge community also provides an opportunity to leverage the learnings and experience from the past winners of the solution. 

Our solution consists of 2 parts

• 1)DIM-T: Designed to integrate with existing DVDMS platform so that it can be scaled up quickly and it will be value addition to existing platform as this tool will address existing shortcomings mentioned in problem statement. DIM-T tool is simple to use, user friendly so that end user can utilize this tool effectively with minimal resources. Tool will be used to forecast demand of various drugs and consumables so that indenting of drugs will be more accurate to improve drug availability and rationalization of drugs as per need. This tool will serve as bridge to improve health systems efficiency and will improve quality of care.
• 2)Prototype tool for Sub-centres: A major gap in the present supply chain is the disconnection from the last mile health delivery point (SCs) from the online system- DVDMS. Our innovative prototype tool would allow the inclusion of SCs into the larger supply chain rendering a more effective and efficient supply of drugs at grass root level. 

Describe why your solution provides a new or significantly improved approach to the problem. Explain how it could be catalytic: do you expect it to change the market or enable broader positive impacts from others in this space? How?

Our solution is multifaceted and holistic which intends to deal with the issue of inefficient supply chain from multiple directions. It also intends to bridge the existing gap in supply chain at the sub centre level, while simultaneously providing for a forecasting tool at PHC level thereby making indentation and drug supply requests more systematic and evidence-based. This solution has the potential to set the ball rolling for improving supply chain indicators, first in the state of Maharashtra and then across the country. Since both solutions would be built with open APIs, the aim would be integration and scale up with existing government platforms.

Impact goal for the next year:

To pilot DIM-T tool in Satara District of Maharashtra/Select geographies at the primary health centers and sub-centers

Achievement plan:

Along with Dept of Health and Family Welfare Government of Maharashtra currently we are working in Satara district on comprehensive primary health care project to create a model district. We plan to deploy and implement this solution along with our existing intervention which aligns with our interventions for strengthening of supply chain management.

Piloting of the tool and prototype will be done through close collaboration between our field team and facility staff. Our organization will provide necessary end to end technical and financial support for implementation and operationalization of tool.

 Impact goal for the next five year:

1. Integration of the DIM-T tool  with existing DVDMS platform
2. Scale up of the DIM-T tool through the State in collaboration with government and relevant stakeholders
3. Support to government in operationalization of scale up of tool through capacity building and technical support
4. To build a sustainable solution for efficient supply chain management of essential drugs, vaccine and consumables through further innovation and modification in DVDMS post integration and scale up.

Achievement plan:

Currently PATH is working in India along with Ministry of Health and Family Welfare, National Health System Resource Centre, Centre for Development of Advanced Computing and various state government on different thematic areas of public health where PATHs core strength is utilization of newer technology, deployment of Innovation and Collaboration. To achieve impact goals, PATH will collaborate closely with governmental and non-governmental stakeholders with whom we have been working closely. 

Measurable Indicators of goal for the next year:

• No. of facilities where DIM-T tool was piloted
• No. of SCs where DVDMS-like prototype was piloted
• No. of users trained for using DIM-T tool
• No of essential drugs stockout in a healthcare facility in a month
• No of essential drugs stockout days in a healthcare facility
• Accuracy of drugs forecasting by the facilities

Measurable Indicators of goal for the next five year (In scale up phase):

1. Integration of DIM-T tool with DVDMS
2. Integration of sub-center prototype with DVDMS
3. Use of the tool to redistribute stock amongst facility based on data
4. No. of states which adopted the DIM-T tool
5. No. of states which adopted the sub-center prototype
6. No of essential drugs stockout in a healthcare facility in a month for state and district
7. No of essential drugs stockout days in a healthcare facility for state and district

Scaling up this intervention will contribute to achieve SDG 3, to be precise will help in achieving target 3.1 to 3.8 of SDG 3.

Our theory of change for this tool to bring out positive change lies in simplicity and user friendliness of our solution because absence of this core component in existing DVDMS system is leading to poor uptake of portal leading to irrational essential drug supply and inefficient chain management causing stockout of drugs is the reason for not limited availability of quality and continuum of care at healthcare facility level. Second important component, this tool can be used for forecasting drug requirement which will help in advance planning and will ensure timely procurement and supply of drug till end user. This tool will improve uptake of online indenting will help in rational drug supply and efficient supply chain management will lead to no drug wastage, no drug expiry and will ensure equity and drug availability at healthcare facility resulting in improved quality of care, continuum of care to beneficiaries and it will be a catalyst for health system strengthening.

DIM-T is excel and web based forecasting and supply chain management tool, simple to use, user friendly. It leverages the data being captured in the healthcare systems to support the decision-making related to inventory management including drug distribution and redistribution. The tools will also generate alerts which will be transmitted through SMS to the functionaries responsible for the action. Through an open API based solution we can leverage existing government owned DVDMS web-based platform by integrating DIM-T tool.

PATH's field staff with Cooperation of the service provides will be collecting the data for our solution. 

At PATH, we are a global team of innovators working to accelerate health equity so all people and communities can thrive. We recognize that to achieve our mission of global health equity, we must renew and make explicit our commitment to diversity, equity, and inclusion both in our programming and in our organizational culture. The current team working on strengthening the primary health care system consist of the members from diverse cultural backgrounds belonging the different states of India. The gender ratio of the team is balanced with the leadership of the primary health care division vested in women leaders. In its working PATH is a flat organization providing equal opportunity to every of the team members to freely express their opinion, demonstrating their capabilities and leading initiatives. During the implementation also PATH is sensitive of the needs of the vulnerable and marginalized sections and therefore prioritizes the needs of these section through strengthening of the public healthcare systems. 

At PATH, we are a global team of innovators working to accelerate health equity so all people and communities can thrive. We recognize that to achieve our mission of global health equity, we must renew and make explicit our commitment to diversity, equity, and inclusion both in our programming and in our organizational culture. The current team working on strengthening the primary health care system consist of the members from diverse cultural backgrounds belonging the different states of India. The gender ratio of the team is balanced with the leadership of the primary health care division vested in women leaders. In its working PATH is a flat organization providing equal opportunity to every of the team members to freely express their opinion, demonstrating their capabilities and leading initiatives. During the implementation also PATH is sensitive of the needs of the vulnerable and marginalized sections and therefore prioritizes the needs of these section through strengthening of the public healthcare systems. 

We’re powered by partnerships, For more than four decades, PATH has been a trusted partner to government leaders, social investors, grassroots groups, and businesses of every size and type. We are a global nonprofit improving public health, our most of financial resources are from and will be from individuals, corporations and global partners. We started in 1977 with a modest grant from the Ford Foundation. Today, thousands of institutions and individuals invest in our work to make good health accessible to people everywhere. In 2021our sources of revenue came from 47.6% - foundations, 25.7% - US government, 21.3% - other government NGOs, multilaterals, 1.9% - Investments, 1.7% - Individuals/others, 1.7% - corporations.

For more details you can visit finances section of our global website https://www.path.org/about/finances/

To initiate the pilot of the prototype, we will be relying on donors and grants that invest in digital solutions for improving primary health care. This will enable us to pilot and the program, understand its working in government setup and build evidence for government adaptation of the solution. This will set the premise to leverage government allocated funding for prioritsing digital infrastructure in enhancing quality of service delivery and care with proven applicability and utilization.

We started in 1977 with a modest grant from the Ford Foundation. Today, thousands of institutions and individuals invest in our work to make good health accessible to people everywhere.

As per 2020 financial summary PATHs revenue (in thousands) Foundations $157,000 US government $64,169 Other governments, nongovernmental organizations (NGOs), multilaterals $55,645 Investments $14,872 Individuals/other $5,305 Corporations $6,232 TOTAL REVENUE $303,223.

As per 2020 financial summary PATHs expenses (in thousands) Program-related: Global health programs $ 87,506 Essential medicines $42,496 Technology, analytics, and market innovation 24,282 Other $5,504 Program development $2,308 Subawards to program partners $92,348 Subtotal program-related $254,444 Administrative $ 37,600 Fundraising $2,325 TOTAL EXPENSES $294,369. PATHs Annual Reports and Consolidated financial statement for previous years can be accessed on global website https://www.path.org/about/finances/financial-documents/