Progress Report eVIN Roll-out in Jan- Dec 2018

1 A brief state profile of MADHYA PRADESH ...... 3 Introduction: eVIN & UIP in Madhya Pradesh ………………………...... 3

Overview: Vaccine Logistic Network in MADHYA PRADESH ...... 4 Manpower: eVIN team in MADHYA PRADESH ...... 5 How eVIN Works: ...... 5 Support to UIP in Madhya Pradesh ...... 7 Financial Report: ...... 8 eVIN Dashboard Indicators ...... 8 eVIN showcase in Madhya Pradesh……………………………………..…...11

Acknowledgements:

Digitalizing Immunization supply chain is optimistic and challenging task in a huge state like Madhya Pradesh. eVIN team acknowledge the support provided by Mrs. Gauri Singh, IAS, Principal Secretary, Health, Dr Pallavi Jain Govil, IAS, Commissioner Health, Mr Nishant Warwade, IAS, Mission Director, NHM, MP & Dr B N Chauhan, Director Health Services & NHM Madhya Pradesh for their invaluable support and guidance during eVIN Roll‐ out and eVIN transition to the NHM. eVIN team express heartfelt gratitude towards Mr V.Kiran Gopal, IAS, Ex‐MD NHM, MP, Mr S. Vishwanathan, IAS, Ex‐Mission Director, NHM,MP, Dr Santosh Shukla, SEPIO Madhya Pradesh, Er Vipin Shrivastav, SCCO, MP for being instrumental in utilizing eVIN for strengthening vaccine logistics and cold chain management in MP and projecting it as a sustainable model. eVIN team acknowledges the support extended by State NHM team for extending support to sustain eVIN with NHM resources and all the tireless efforts of the concerned officials of districts, the CMHOs, District Immunization Officers, state vaccine stores, district vaccine stores, cold chain technicians and cold chain handlers for their vital roles in eVIN implementation and its continuation in Madhya Pradesh. eVIN team is committed to strengthen Vaccine Logistics and Cold Chain management in Madhya Pradesh and will continue to excel and project Madhya Pradesh as an Ideal Supply Chain management model for the country.

2 State Profile: Madhya Pradesh

As its name suggests, Madhya Pradesh is situated in the very heart of India. It shares its borders Location with five other states viz., Rajasthan in the north-west, Uttar Pradesh in the north, Gujarat in the west, Maharashtra in the south and Chhattisgarh in the north-east.

Area The state spans over a geographical area of 3,08,000 sq.km.

The state, by and large, tends to have a pleasant moderate climate round the year, sometimes Climate interspersed with extreme weather. Regions

Regions , Nimar, , Baghelkhand, Chambal and Mahakaushal.

The main language of communication is Hindi. In and around the places viz., Bhopal, Sironj, Languages , Kurwai etc., Urdu mixed with Hindi is commonly used. Different dialects in different regions are spoken like Bundeli in Bundelkhand, Malwi in Malwa, Nimari in Nimar, Bagheli in and Dialects Baghelkhand and Bhili and Gondi in Tribal areas of , Mandla, Dindori, Balaghat and Seoni districts.

Means of Agriculture is the main source of livelihood of a large number of the people of the state. About 150.75 lakh hec. area is under cultivation and above 70% of total working population depends on Livelihoods agriculture sector.

Main Crops Soybean, Wheat, Paddy, Jowar, Maize, Gram, Masur, Tuar, Mustard.

Rivers Narmada, Chambal, Mahi, Tapti, Betwa, Sone, Banganga, Ken, Pench, Tawa and Shipra.

Madhya Pradesh takes pride in having the country's largest forest coverage of 94689.38 sq.km. Out Forest Area of 94689.38 sq.km., 61886.49 sq.km. is reserved forest, 31098 sq.km. is protected forest and 1705.85 sq.km. falls under unclassified forest.

Introduction:

Madhya Pradesh has got highest Forest areas in the Country after Assam. It has got 21 Tribal districts with 89 blocks with Tribal population. Tribal, hard to reach, forest areas lack infrastructure development in terms of network in some parts of MP. Health infrastructure and availability of human resources are major concerns in the state. The state is relatively sparsely populated, with an average population density of 230 per square kilometer, compared to the country average of 274 per square kilometer. Madhya Pradesh is the second largest state in the country and accounts for 13.5 percent of the total area of India. The state is organized into small hamlets fragmented throughout the state. This geographic arrangement makes it difficult to position and develop health centers in the state. India conducts one of the largest Universal Immunization program (UIP) in the world. The coverage is more than 26 million newborns and 30 million pregnant women each year translating into more than 30 million doses of vaccine each year. At Madhya Pradesh, there are total 4 Regional Vaccine Stores, 3 Divisional Stores, 51 District vaccine stores and 1126 Cold Chain Points (CCPs) in which 95% are below the district level. The full immunization coverage for infants is 56% (NFHS 2015‐16) in Madhya Pradesh. A key challenge for Madhya Pradesh in realizing its vision of 100 percent immunization is to address inadequate vaccine logistics and temperature monitoring systems right from manufacturer down to the mother and child. The availability of quality vaccines at session sites is a contributor to low coverage.

3 The Madhya Pradesh was the first state in India to launch Electronic Vaccine Intelligence Network (eVIN)under GAVI Health System Strengthening (HSS) support. During the training 2480 CCH & Link mobile handset (smartphone) by the United Nations Development Programme (UNDP) with Data sims by the National Health Mission (NHM), amounting to Rs. 5 lacs per month approx. Post implementation the Vaccine Cold Chain Managers (VCCMs) monitored the work of CCH and gave feedback to the District Level Managers and corrective measures were taken. This resulted into:

Digitalization of Vaccine Logistics/records Real time monitoring of vaccine temperature Reduction in Vaccine wastage Reduction in discards Shortening of pipelines for vaccines Reduction in wastage of short expiry vaccines. E.g. DPT.

With UNDP funding for eVIN ending in December 2017, it has become crucial to continue with the activities under eVIN to sustain the results achieved so far. During the video conference held on 15th September 2017 to discuss transition and sustainability plan for eVIN under chairmanship of Shri Manoj Jhalani, ASMD (NHM), Govt. of India, it was decided to include HR, operational and implementation cost under state PIPs. In 2018, Madhya Pradesh, State NHM has signed an MoA with UNDP to implement eVIN with domestic funding.

Overview: Vaccine Logistic Network in MADHYA PRADESH:

4 eVIN team in Madhya Pradesh

For the smooth Roll‐out of eVIN across the state, UNDP deployed following resources at State, Divisional and District level.

•Senior Project officer (1) •Project officer IT (1) State •Accounts & Finance Asst (1)

•Project officer- Operations (6) Divisional

•Vaccine and Cold Chain manager (51) District

How eVIN Works: eVIN enables real‐time visibility of vaccine logistics and cold chain by digitizing stock supplies and storage temperature across vaccine cold chain points in India. And thus visibility of real time vaccine stocks and temperature data through eVIN is strengthening the evidence base for improved policy‐making in vaccine delivery, procurement and planning for new antigens. eVIN gives solution to three crucial questions related to vaccine logistics and cold chain management:  Where are my vaccines?  Are they available in adequate quantities?  Are they being stored in appropriate conditions?

eVIN is made up of three components –  Processes (Standardisation of record keeping tools)  Product (Technology consisting of eVIN mobile based application and remote temperature loggers)  People (Strong Human resource network at different levels)

Processes: Under eVIN, GoI has introduced two types of registers, one for recording detailed distribution data on every immunisation session day, and another for recording changes in total stock levels. Government of Madhya Pradesh adopted these registers and revised/customized as per States specifications.

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Standardized Vaccine Stock and Immunization Session Registers in Hindi

Product: The technology in eVIN is a LMIS (logistic management information system) software which is an android based simple mobile application where the vaccine cold chain handler feeds regularly the vaccine and logistics data from the Standardized Vaccine Stock and Immunization Session Registers and the data is sent into a central server through the mobile‐ cloud technology. It also has a Remote Temperature Loggers (RTL) which captures the real time temperature data which is then sent to the same server and both the information gets shared at a single platform and it gets presented in Dashboards. eVIN Dashboard view

RTL is a low cost, SIM‐based remote temperature monitoring system, with 2 sensors for ILR & DF and 5 sensors for WIC/WIF. Sensor unit collects temperature data every 10 minutes and updates eVIN server every 60 minutes. Three types of alarms‐ device, SMS and email sent immediately to any 5 concerned authorities upon sensing temperature breach. People: A strong human resource network at National, State, Regional and District level is deployed under the eVIN project, which works closely with the Government officials at all the levels.  In Madhya Pradesh, the State team –(1 Senior Project Officer, 2 Project Officers – 1 for Capacity Building & Monitoring and 1 for IT and 1 Admin‐Finance Assistant) is responsible for overall management of GAVI HSS project. Team supports the State officials in vaccine logistics & cold chain management and all other aspects of Routine Immunization.  There are 7 Regional Project Officers located at 7 Regional Directors (RD) Office who work closely with the Regional Vaccine Store Managers and give continuous feedback & support to all regional officials.

6  There are 51 Vaccine & Cold Chain Managers (VCCMs) working across 51 districts who work closely with DVS Manager, hand hold the VCCH and provide continuous feedback & support to district officials – DIOs and CMHOs.

What eVIN does?  IMPROVES efficiency of vaccine cold chain logistics management by introduction of state‐of‐the‐art technology for digitizing vaccine stocks.  STRENGTHENS the immunization system by deploying trained human resources in every district for constant support to estimate vaccine requirements and provide supportive supervision.  DEVELOPS standard operating procedures for systematic record‐keeping of vaccine logistics under the guidance of MoHFW.  INFORMS policy and decision‐making for immunization supply chain management at all levels.  EMPOWERS the vaccine cold chain handlers at all health centres through intensive training on eVIN.  ENSURES quality and safety of vaccines through real‐time information on storage temperature with the help of SIM‐enabled temperature loggers.  FACILITATES maintenance of optimum vaccine stocks by reducing instances of vaccine wastage and stock‐out. Support to UIP in Madhya Pradesh

A key challenge for Madhya Pradesh in realizing its vision of 100 percent immunization is to address inadequate vaccine logistics and temperature monitoring systems right from manufacturer down to the mother and child. The full immunization coverage for infants is 53.6% (NFHS 2015‐16) in Madhya Pradesh. Few qualitative & quantitative impact points which eVIN (Electronic vaccine Intelligence Network) has brought to the state of Madhya Pradesh are as follows:

1. Since there is no dedicated cadre of Cold chain Handler in the state, almost 31 types of cadre work as Cold chain Handler. Once trained and equipped with the eVIN mobile and the system package, this cadre felt really empowered and were more accountable towards their duties. This in turn ensured that the state provides safe and quality vaccines in time to the beneficiaries. Almost 2400 cold chain personnel were trained qualitatively in Vaccine logistics and cold chain management, standard Registers along with eVIN.

2. After the advent of eVIN team, the state identified potential Health facilities which can be upgraded as Cold chain points. As a result, 52 new CCPs were made functional. This improved the reach of vaccines to remote areas in time.

7 3. eVIN enabled the state in managing the Cold Chain Vaccine Logistics & Management (CCVLM) in an effective way. Here are few examples for this:

∙ There is a reduction in average vaccine stock out duration from 5 days to 3 days and Reduction in average vaccine replenishment time from 3 to 0.65 days.

∙ After the installation of Temperature loggers and real time alerts the sickness rate and breakdown time has come down due to frequent movement of Cold chain technicians in the districts to repair the CCEs immediately. The CCE uptime has increased to almost 85% which helps in tracking of Temperature of the Vaccine storage. This again ensures quality vaccines for the beneficiaries.

∙ The eVIN team has supported the acceleration of condemnation process of CCEs, as a result the cold chain capacity of the state has improved in terms of quality and the sickness rate has gone down.

4. The eVIN system (process and personnel) helped in smooth rolling out of newer vaccines e.g. PCV and capacity building of VCCH in the newer VCCH module. The team imparted quality trainings in all 51 districts for implementation of Order Management in eVIN to streamline the indenting process in CCVLM of the state. The system helped in tracking the stock & utilisation of the newer vaccines on real time basis (daily monitoring of vaccine utilization through monitoring by the team).

5. The eVIN team also trained all the CCH of the state for implementation of MR Campaign.

6. The eVIN helped the state in ensuring vaccine availability at all the session sites by ensuring all the UIP vaccines at all the Cold chain points. Thus, helping the state in improving the Immunization coverage through Mission Indradhanush, Mission 100 and Intensified Mission Indradhanush. This has been verified by the WHO Monitoring report.

Financial Report  For the month of Jan 18‐March 18 a total amount of Rs. 2,28,03,000 was approved by the GOI in the NHM PIP for eVIN technical Assistance to UNDP. An amount of Rs 2,28,03,000 was deposited to UNDP account by the state NHM. SoE for the Rs. 92,50,244.82 have been provided to the state by the UNDP for the first quarter of Jan to March 2018. The State NHM gave the approval to use the unspent balance for eVIN implementation in the state.  For the Financial year April 18 ‐March 19 NHM MP has signed an MOA with UNDP to implement eVIN in the state. The state is yet to transfer the funds to the UNDP for the current financial year i.e. 2018‐19. eVIN dashboard indicators: eVIN Monthly Dashboard is released from Ministry of Health and Family Welfare every month to share the performance of states for 9 critical indicators. Madhya Pradesh is amongst the better performing states in terms of total average duration of stock out in days, Ativity Rate, vaccine availability Index, CCE Uptime.

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July 2018

Total Average duration of Excess stock in days Sep-2018

20.0 17.4 17.8 18.0 16.7 16.0 13.6 14.1 14.4 14.0 12.5 12.8 12.0 10.5 10.8 10.9 10.0 8.6 8.0 6.6 6.0 4.0 2.0 0.0

Dashboard indicators towards the 2nd quarter of 2018 were affected due to the 10 non functional CCPs in the state, which were deleted from the portal after approval from the state Govt. Aging cold chain equipments and lack of essential spare parts required for repairs are some of the major reasons for low uptime of CCEs in the State coupled with erratic behavior of the CCTs to attend the breakdown.

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eVIN Showcase in Madhya Pradesh:

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