Fiji Pharmaceutical & Biomedical Services Centre is the centre warehouse in Fiji. FPBS is responsible for managing all of Fiji’s health supplies from medicines to x-rays, and distributes those to more than 220 health facilities across the country.

In this video, Alexandro Naisara from the FPBS Stock Verification & Process Control Unit discusses how mSupply is making inventory management faster and easier than ever.

mSupply is the world’s leading Logistics Management Information System (LMIS) for health supply chains in low-resource settings. Beyond Essential is a close partner with the mSupply Foundation and specialises in the implementation of mSupply, leading its implementation across settings in the Pacific, Asia and Africa.

To learn more, visit our mSupply page here.

This project is proudly supported by the Australian Government.

As COVID cases rise across the Pacific, Tamanu is being used to help manage the COVID-19 testing programs in Fiji and Palau. Tamanu is a free, open-source EMR designed specifically for low-resource and remote settings in the Indo-Pacific region.

Using both the Mobile and Desktop versions of Tamanu, staff are recording COVID-19 tests, along with lab results and disseminating this information quickly to contact tracing teams. The system also allows patients to get their results instantly, as soon as they are published by labs. In Fiji, over 50,000 tests have been entered via the system over the last 6 months, whilst in Palau they are one week in and already entering hundreds of tests each day.

As COVID-19 outbreaks spread in countries that were previously COVID free, the system is providing a hugely valuable tool for secure information management. Its ability to collect data offline (syncing when internet becomes available across desktop and mobile) makes it perfectly suited for the Pacific setting.

Our analytics shows that there have been over 60,000 visits to our online results checking tool in Fiji alone, which has therefore saved over 60,000 calls to the national call centre from people trying to find their COVID-19 test result.

The online test results widget in Fiji has been accessed more than 60,000 times

Features of Tamanu for COVID-19 testing:

• Swab teams can record the results of RDTs (rapid tests) using their mobile devices even when offline
• Swab teams can request PCR tests and capture all the details on patient swab forms using their mobile devices, even when offline
• Any laboratory in the country can receive a lab request once it is synced up and enter results using Tamanu Desktop – even if the laboratory loses internet after receiving the request. Results can include all details, including swab type, test type, technician, verification data, status, date/time and additional notes
• Patients can receive their results via a Certificate that is automatically generated
• Patients can check their results or verify it to external parties by using our online widget tool and entering a unique code they are given when being tested
• We can push results via an API to external systems or encode the data in Visible Digital Seals (QR Codes) in accordance with international standards

Like all Tamanu modules, the system is completely free and open-source, with funding support from DFAT’s Indo-Pacific Centre for Health Security. Tamanu can also be used to manage active COVID-19 patients across inpatient and home settings, collect contact tracing information and has a complete immunization module to record COVID-19 vaccines.

Please contact us for a demo or to join upcoming webinars.

This project is proudly supported by the Australian Government.

BES is working with the United Nations Population Fund (UNFPA) Pacific Sub-Regional Office (PSRO), to support the ‘Transformative Agenda for Women Adolescents and Youth in the Pacific’. The Transformative Agenda (TA) programme invests in improving sexual and reproductive health in six priority countries: Fiji, Kiribati, Samoa, Solomon Islands, Tonga and Vanuatu.

UNFPA is using Tupaia to build a real-time, regional map of reproductive health services and commodities. In Tupaia, data is coming in from multiple sources to populate visuals showing information important to planning reproductive health services. This allows regional bodies to target services and resources to the areas of the greatest need, with a focus on supply chain strengthening.

The programme seeks to reduce unmet family planning needs in the Pacific, with three identified programme outcomes: increased and improved supply of integrated sexual and reproductive health (SRH) information and services, particularly for family planning; increased demand for integrated SRH information and services, particularly for family planning; and a more conducive and supportive environment for people to access and benefit from quality SRH, especially contraceptive choice.

How does it work?

Every health facility across countries was surveyed initially to provide a baseline level of information on the availability of reproductive health commodities, equipment, medicines, human resources and services. This data was imported into Tupaia and is built upon yearly, when each facility is again surveyed during a National tour.

During these tours, our mobile data collection app Tupaia MediTrak is used to collect updated data from the health facilities, allowing graphs over time to show any progress as to the improvement of services, or to direct where further support would be of benefit. The data can be shown at facility level, or aggregated to give an overall view of how a district or province or country is tracking.

Included in this data collection process is an ongoing import of data into Tupaia on staff training. This includes information on which facilities have had staff attend trainings and what they have been trained on, to help address training gaps where they exist in provinces or facilities to ensure all women have access to a facility with sufficiently trained staff.

On Tupaia, you can see exactly what supplies each clinic has in stock

Through Tupaia, we have data coming into the reproductive health platform about family planning commodity availability for those countries that use the stock management system mSupply (Kiribati, Solomon Islands, Vanuatu, and Tonga) at the national medicines warehouse.

BES also supported the roll out of mSupply at the UNFPA central warehouse in Suva, Fiji. From this warehouse, Pacific Island Countries can order required family planning commodities, and now the warehouse is able to use the forecasting, tender and procurement functions in mSupply to ensure there is always sufficient stock to meet these needs.

What this means is that stakeholders can look at Tupaia and quickly identify the supplies that are available at each health facility across all six countries in the region. One facility may have condoms and IUDs but is running low on emergency contraceptives. Another facility nearby may have plenty of emergency contraceptives, but no services for pregnancy testing and insufficient condoms available.

The availability of country level stock status information from mSupply allows UNFPA to detect regional supply issues, country level supply issues and sub national bottle necks and provide support and advice as required. Next steps for this project include adding live information on the availability of items at the Fiji warehouse to Tupaia, so there is oversight at each country level on the availability of items within the Pacific.

In Tonga, the Reproductive Health team in the Ministry of Health can view the UNFPA reproductive health module described above, as well as other important data they need to support decision making and reporting – all within Tupaia. Tonga uses Tupaia to display Health Information System (DHIS2) data (such as contraceptive prevalence rate), and this data is captured at the facility level using Tupaia MediTrak. We thus have a growing workforce of people becoming adept at using the MediTrak data collection tool and using Tupaia to view a range of health data, so staff need only learn to navigate a single system to collect and view the data they need.

In Kiribati, the physical monitoring and the monthly review of mSupply reports have contributed to increasing the share of health facilities with no stockouts of any contraceptives from 2 per cent in 2019 to 67 per cent in 2020. Not just that, but data indicates the increased use of family planning commodities and a rise in couple-years protection.

The future of reproductive health in the Pacific

The long-term impact this project strives for is greater oversight as to the availability of reproductive health services in each of the participating countries. Countries will be able to use Tupaia to show where, for example, facilities offer family planning services, and where there are gaps in the family planning commodities available to support the offering of these services – and support Ministries of Health to plan to rectify these discrepancies.

The overall aim is to improve service availability to all women living in the 8 participating countries by ensuring they have the commodities, equipment and staff available to meet family planning and reproductive health needs.

Want to learn more about Tupaia? Visit our product page here.

Want to explore the data yourself? Check out tupaia.org

Treating a broken arm does not generally require an extensive knowledge of the patient’s medical history. But when it comes to non-communicable diseases (NCDs) such as cardiovascular disease, chronic respiratory disease and diabetes, that knowledge is crucial.

NCDs are the leading cause of death in Pacific Island countries, accounting for between 60 and 80% of mortalities. In countries such as Fiji and Samoa, diabetes is the leading cause of disability. Lower limb amputation for diabetic gangrene is the most common surgical operation in Fiji, a stat that could be reduced by earlier detection and more consistent treatment plans.

A consistent treatment plan improves outcomes for NCDs such as diabetes

In simple terms, to manage diabetes you need to keep a person’s blood sugar low over the long term. That’s hard to achieve even in the most well-resourced settings, but what really sets it back is arbitrary changes to a person’s eating plan or drug regimen.

In order to know whether a new treatment is working, you need to know whether their fasting blood sugar is improving or getting worse. If you don’t have a person’s medical history, and they return a high blood sugar reading, you might be inclined to think a drastically new treatment is required. But if you had a record of previous tests, and know that their blood sugar is actually improving, then you’d keep the drug the same and maybe make small tweaks to the dosage.

On the other hand, a mildly high reading could be a real concern if that person has never had elevated blood sugar reading before. You would want to monitor the situation closely. If you didn’t know their medical history, you might miss the early warning signs.

Paper-based record systems are an obstacle to proactive healthcare interventions

Paper-based record systems are almost always tied to a single location. If a person’s only interaction with the healthcare system is with a single clinic, that might not cause any issues. That situation, however, would not be likely or desirable. Paper-based records can be put into the hands of patients, of course, but these are too easily lost or damaged and patients may not have access to these paper records when they are at their most vulnerable (such as when they’re going through an emergency medical situation).

Health care in the Pacific Islands – like in many settings – is typically reactive: a person has a specific concern about their health, so they visit a health facility and are treated for that concern. This is a big problem when it comes to NCDs, because these isolated visits can be siloed from each other and knowledge about the patient doesn’t build up – it’s often not until very late in a disease’s progression that you notice its insidious effects.

These are problems we’re trying to solve. We’re currently rolling out an NCD screening tool as part of our electronic medical record (EMR) software project, Tamanu. The aim is for nurses to go out into the community, into schools, identify people who may be at risk, and develop action plans for people to follow. From there, people at risk might follow up at their local clinic, a hospital, or a diabetes centre, for further diagnosis and treatment.

Using a paper-based system, this kind of proactive community outreach would be incredibly challenging. By using Tamanu, every professional in the person’s continuum of care will be able to access their treatment plan and update it, making sure that treatment is consistent, comprehensive and coordinated. Tamanu is also a sync-enabled system, allowing health workers to enter data (on mobile or desktop) when offline, allowing them to access patients in even the most remote settings.

Electronic medical records create more trust in the healthcare system and more willingness to engage with it

Anyone who’s ever interacted with a healthcare system in any country knows the frustration of filling out forms and giving a detailed and personal medical history, only to be referred onto another facility and asked to go through it all again. Intimate discussions of your health conditions and body can make you feel vulnerable, and it’s difficult to put yourself through it time and time again.

Beyond the sheer hassle of it, it feels like no one’s paying attention to you or putting in the effort to remember you. It starts to feel pointless and that experience is no different for people in the Pacific Islands.

If we want people to engage with the healthcare system, we have to make the experience positive for people. Electronic medical records are one way to do that. They reduce the friction and they make people feel seen, because each new healthcare professional they interact with is already familiar with their history.

Improvements to basic processes don’t attract headlines the way new drugs do, but they make a huge difference to the healthcare system and to people’s lives.

“Electronic medical records improve quality of care, patient outcomes, and safety through improved management, reduction in medication errors, reduction in unnecessary investigations, and improved communication and interactions among primary care providers, patients, and other providers involved in care.”
– Donna P. Manca MD MCLSC FCFP, Do electronic medical records improve quality of care?

This project is proudly supported by the Australian Government.

We have three main aims for this project:

• Improve the availability of medicines at the primary healthcare level
• Lower medicine costs nationwide
• Achieve more equitable access to medicine for all citizens

Ensuring the Right Medicines of the Right Quality and at the Right Price are available at the Right Time, in the Right Place in the Right Quantities.

That’s a lot of separate pieces to get right! This is why we started by evaluating how those pieces look in the current Fijian Health Supply Chain. We have already completed an extensive health supply chain review on the ground, which involved:

• > 30 meetings  held  with  senior  internal  and external stakeholders
• 230 documents and template forms reviewed
• 7 facilities visited
• 3 consultative presentations  with  the  MHMS Executive

What we found was that while there are some definite strengths in the current system, there are several issues that  can be addressed.  These include strengthening the data informing supply so that  the stock issued to medical facilities better meets their actual demand. We also want to streamline and digitize the procurement process and improve workflows in the main warehouse.

The strengthening work will include, implementing two key digital platforms. The first is mSupply. It is a proven, effective, scalable Electronic Logistics Management System (eLMIS), which we will use to improve the supply chain management of essential medicines. It will be integrated with the second digital platform, our own Tupaia, which will be used to map the national health system and provide an accessible, intuitive visualisation of commodities across all facilities in near-real time. Tupaia will additionally support disaster response, cold chain management, and quality use of medicine interventions. We are confident that with this targeted approach and combination of digital systems, we can help to significantly improve access to essential health supplies across Fiji.

Most importantly, our partners at the MHMS and Fiji Pharmaceutical and Biomedical Services (FPBS) are as excited as we are about getting started and have committed the resources required to action change. Our role, above all, is simply to support them as best we can.

For the duration of this project, our key staff Michael Nunan (Project Executive), Emily Porrello (Delivery Lead) and Dhanya Herath (Software Lead), along with the rest of the BES team and the mSupply Foundation, look forward to working directly alongside stakeholders from MHMS, FPBS and across the Fijian government. We are excited to understand and design systems that deliver real impact.

If you’re interested in learning more about the project, or want to check out some of Tupaia’s features for yourself, log into www.tupaia.org and explore the data.

This project is proudly supported by the Australian Government.

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