Jessica believes that ‘continued ‘South to South’ cooperation in the region can foster stronger relationships and increase the potential for healthcare workforce mobilisation in the Pacific’.   

Everyone in the Pacific benefits when Pacific islands can request staff support with broader experience and knowledge during staff shortages, emergencies, and crises and to support health campaign rollouts. Exchanging skills and staff within the Pacific has the added benefit of cultural understanding and nuance. This knowledge shortens the learning curve in a new setting for staff with greater familiarity with similar healthcare challenges. 

The regional skill exchanges work towards cultural and contextual understanding. They focus on respect for national sovereignty and shared responsibility, strengthening the region’s healthcare systems. 

Knowing how to communicate culturally and speak with a regional voice is more likely to lead to real and effective change, even in the diverse language and cultural systems of the Pacific region. 

‘Knowing the software is one thing, but looking around and seeing what can be improved diplomatically so that real change happens is important too’, says Elizabeth Bryson, who visited Niue on the DTAC program skills exchange from the Cook Islands. In April, DTAC invited Elizabeth to visit Niue to support the move from paper to digitisation of their pharmacy systems by implementing mSupply. 

 Elizabeth arrived in Niue with the public health team and got straight into the stocktake of one of their three locations. She met with the pharmacy team and had many suggestions to help to create a safer and more efficient workplace, skills she had already learned from her work in the Cook Islands.

As a champion of change, Elizabeth believes that ‘’Building relationships is so important across the Pacific.’ She never imagined that she would ever visit Niue to support their health system, but now she can see that it is a practical solution with so much to gain from both sides. She takes with her skills and knowledge that will impact a project she is working on in the outer islands of her country, where the medicine supply can be difficult to manage. 

Elizabeth hopes that regional collaboration can continue between countries in the Pacific and that she can take the lessons learned from her experience to continue to strengthen health systems in the Cook Islands. She can see that the much more isolated Niue and outer Cook Islands have some similarities – and she now has some insight into possible problems and solutions because of her experience with skills exchange in Niue. 

BES and the mSupply Foundation support the Pacific skills exchange through peer-to-peer networks between PICTs with the support of DFAT and MFAT.

Elizabeth Bryson (The Cook Islands Ministry of Health) and Jessica Jago (DTAC) enjoy beautiful Niue in between stocktakes. The Pharmacy Dispensary Team: Ebony Feleti and Seddon Paka with Elizabeth Bryson from the Cook Islands Ministry of Health. The Public Health and Nursing Team, organising a stocktake of their medical consumables: Andy Manu, Reuben Siataga with nurse, Fonokalafi Moleni, and Jessica Jago (DTAC Project Manager). Ebony Feleti, organising the pharmacy. Team photo celebrating the launch of mSupply for the Public Health Department in Niue. Jessica Jago and Elizabeth Bryson after a long day of stocktake. Nurse, Fonokalafi Moleni in the pharmacy.

With initial funding from the New Zealand Ministry of Foreign Affairs and Trade (MFAT), the project aims to improve access to essential medicines and will support long-term health system development in the wider Indo-Pacific region. MFAT’s funding will support initial implementation in 6 Polynesian countries – Cook Islands, Niue, Samoa, Tokelau, Tonga and Tuvalu – until 2025. We will spend the coming weeks and months forming an advisory panel made of representatives from each of these countries and signing MOUs with each. Other countries are invited to formally join and utilise DTAC’s support, whilst the resources we develop will be released for free use across the entire region.

Working in close collaboration with local staff, DTAC will support partner countries in setting, meeting and surpassing minimum regional standards in essential medicines access, health supply chains and associated digital health systems.

All in-country services provided by DTAC will be provided free, including deployments of mSupply and Tupaia, training sessions, procurement and warehousing reviews, annual quantification assistance, and support for basic auditing and research. DTAC will also provide support, system integrations or maintenance where requested to other digital systems, with particular experience in supporting and implementing DHIS2.

Importantly, the Centre has been designed with a strong focus on capacity-building, aiming to build a peer-to-peer network of local mSupply experts and skilled staff capable of maintaining health supply chains across the region. We envision a future in which technical capacity needs can be met by south-south collaboration between partner countries – this is a model we have demonstrated as recently as last year, when Agusto dos Santos (Timor-Leste) led the roll-out of mSupply Mobile in Solomon Islands (link).

DTAC will additionally aim to foster closer collaboration between countries on medicines quality assurance, identification and prequalification of suppliers, sharing of price information, clinical pharmacy training tools, research and IT capacity. This will be supported through the further development of mSupply’s ‘Health Supply Hub’. The Health Supply Hub expands on mSupply’s existing tender module and will allow countries to post tenders, receive bids and manage quality assurance documentation. Suppliers will be able to post price catalogues and availability data for emergency supplies, maintain a single repository of quality assurance documentation and submit bids in a standardised format amongst all participating countries.

In addition to individual country support, the DTAC is also developing broader global initiatives including a 7-level accreditation system recognising the skills of international mSupply users and providing a structured learning system for mastering mSupply, which is now used in more than 30 countries worldwide. We expect to launch the mSupply accreditation system in 2020.

We see DTAC as an important long-term facility supporting access to essential medicines in the Indo-Pacific region and hope to see its services expanded to more countries in the near future.

For more information, please contact:

Emily Porrello (emily@bes.au)

Michael Nunan (michael@bes.au)

Craig Drown (craig@msupply.foundation)

Part of this funding will enable the mSupply Foundation (mSupply) and Tupaia Health Resource Mapping to work in partnership to develop a new Regional Health Supply Chain Centre in the Pacific. This resource will be rolled out to support Cook Islands, Niue, Samoa, Tokelau, Tonga and Tuvalu over the next five years.

The new digital health centre will strengthen all aspects of the health supply chain and is intended to increase pharmaceutical management capability, implement and integrate data management software, improve essential medicines lists and streamline procurement, warehousing and distribution systems.

Craig Drown, the Director of the mSupply foundation said, ‘the Regional Health Supply Chain Centre will help to optimise supply management systems and cut supply-chain costs associated with manual stock management reporting processes. Improved procurement and reporting tools and the chance to provide far more training will save health clinics in remote, Pacific countries valuable time and money.’

Initially, mSupply will be implemented (or expanded) in Tuvalu, Niue, Cook Islands to introduce mobile-based reporting and follow-up training and support will follow in countries who are already utilising this technology, with Tonga as a high priority.

Tupaia will play an important role in supporting health clinics and health workers in each country to understand and adopt new digital health reporting tools and systems through linking together existing software systems, providing real-time data visualisations and facilitating training. This will allow clinics to have oversight of what health resources are available across the region – via the Tupaia MediTrak app – and use live supply chain data to help inform decision making, efficiently target training resources, remove barriers to accessing essential medicines, and track medicines usage issues, such as those relating to antimicrobial resistance or opioid misuse.

This project will also see mSupply develop a new open-source Supplier Hub which will allow pharmaceutical suppliers and wholesalers to manage their interactions with countries electronically.

‘The Supplier Hub is a real game changer for health workers who manage medicine logistics. This will be the first full Supply Hub that will allow supplies and countries in Polynesia to coordinate and manage stock requests, tenders, Quality Assurance, traceability and forecasting in one application, in real time’, said Craig.

Previously, much of this reporting has been paper based and it has been impossible for health clinics to know what stock exists, where, and when orders will be received, making it extremely hard to coordinate logistical operations.

The Supply Hub will help solve this problem, by enabling better communication, document sharing and transparency between stockists and suppliers so that deployment of medicines can be tracked and monitored.

www.medqualityassurance.org