Sunsets over endless horizons? Waving coconut palms and tropical fruit? Dolphins leaping into the air from crystal clear waters? Local fisherman in hand-carved canoes traversing a calm lagoon?

Ah, all those things. Oh and cyclones. And tsunamis, earthquakes, volcanoes, landslides, flash floods … and more cyclones.

I really do hate to spoil the romance but the beautiful countries that dot the Western Pacific really are among the highest risk in the world when it comes it natural disasters due to a cocktail of continental plate boundaries (which cause earthquakes) and a massive body of warm water (causing cyclones).

In the first three months of 2018 alone, the Pacific was hit by Cyclone Gita (striking Samoa, Tonga and southern Fiji), Cyclone Hola (striking Vanuatu), a continuation of volcanic eruptions on Ambae (Vanuatu) and a series of massive earthquakes in Papua New Guinea.

These natural disasters impact everything: houses, water supplies, roads and electricity systems, individuals, schools, government services … and — often more critically — health facilities.

In disaster response, getting information to the right people as quickly as possible is absolutely critical. This is where Tupaia is helping.

Tupaia provides a map pinpointing every health facility across ten countries in the Pacific

When a disaster strikes, local and international response and recovery teams mobilise to assess the damage. These teams aim to restore critical services as quickly as possible — particularly medical care.

Pre and post disaster surveys in Tupaia MediTrak

Tupaia is available to these response teams with a secure, online/offline data collection tool in Tupaia MediTrak, a free application for Android and iOS that can be used to assess and record damage. The app automatically pushes information to a data aggregation and visualisation platform that displays what medical services and facilities are available or affected. Information can also be aggregated in real-time from disease surveillance platforms or weather apps. Where the recovery effort is likely to be drawn out, Tupaia functions as an essential tool in establishing what interim services are needed to cover the gaps.

In a disaster, network connection is hardly reliable, so Tupaia MediTrak allows response teams and health staff to collect data offline, which will sync when the mobile device comes back into range. As soon as Tupaia syncs, the data is made available to local disaster response coordinators, donors and experts around the world. Responders can even take photos within Tupaia MediTrak, which are then displayed on the website, providing an accurate representation of the situation on the ground.

Tupaia provides a clear picture of disaster affected facilities

The disaster module at Tupaia.org presents an interactive map of health facilities, showing information about each facility, including their status in the wake of the disaster. Information can be viewed at the national level, the provincial level, and at the facility level, making it a useful tool for decision makers and responders at every level. Data is also secure, with powerful security features and the ability to grant permissions at a highly granular level so that different users need only access data relevant to them.

An example from the field: Tupaia surveys being conducted in difficult weather

After Cyclone Gita struck Tongatapu in Tonga in February 2018, Tupaia was used to assess all health facilities in the wake of the huge storm. Within 48 hours, data had been collected from all seven facilities on the affected island. This could immediately be compared with baseline data collected several months earlier, so response teams could see how measures of water, electricity and available services were impacted by the cyclone. The Tupaia app also allowed pharmacy staff to take photos of the damage, which could be compared with photos taken at the baseline stage.

Live dashboards were made available to the Ministry of Health and incoming response teams from Australia and New Zealand and they were able to use that information to quickly plan their response and direct resources.

What’s more, this process ultimately saved money. The rapid assessments showed the damage to health facilities was, in fact, minimal and that resources should be directed towards communities and other public infrastructure (including water supplies) that had suffered much worse damage.

Tonga suffered widespread damage from Cyclone Gita in February 2018. Source: Reuters.

In Tonga, Tupaia helped maintain confidence in the health system and prevented an influx of unneeded medical teams and equipment. It might seem counterintuitive, but this certainly demonstrates that showing data on a lack of damage[1] can be just as valuable as showing the damage itself.

Unfortunately, the prevalence and intensity of a lot of natural disasters in the Pacific are set to worsen. For cyclones, this is as climate change accelerates and global sea temperatures rise. The impacts of landslides, earthquakes and tsunamis are also worsening, thanks to coastal erosion and deforestation in unstable, mountainous areas. More than ever, it’s crucial the region is prepared.

Here at Tupaia, we’re continually working to improve the disaster response capabilities to make sure that only the most relevant and meaningful data is being collected (in emergency situations, asking meaningless questions can cost valuable time). We are aware many people using tupaia.org post-disaster are accessing the website for the first time, so we are also working to make sure all maps and dashboards are clear and intuitive.

Check out tupaia.org and have a look for yourself. Cyclone Cyber is currently wreaking havoc on the fictitious country of Demo Land. While this is dreadful news for the equally fictitious inhabitants of Demo Land, it does provide a great chance for you to see the full disaster response functionality in action.

This resource is available to all Pacific Island countries for free. Let’s make the most of it for the benefit of the wonderful people who live there.

[1] Note: This is not to say that health facilities suffered no damage from Cyclone Gita but overall the buildings stood up to the Category 5 storm remarkably well — some smashed windows and minor water damage were noted, which could be appropriately triaged for when other issues had been addressed.

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

Georgia first joined the Tongan Ministry of Health as a health information systems support officer in 2019. Working in partnership with the Beyond Essential Systems, her role focused on supporting the digitisation of health and medical stock records, and the expansion and rollout of mSupply, a system that tracks patient and medical stock data. Georgia’s passion for using technology to drive efficiencies and quality improvements in health care motivated her to return to Tonga in 2020 to assist with the digitisation of COVID-19 vaccination data.

Georgia’s return to Tonga for her second volunteer assignment is seeing her assist the Ministry of Health in using the mSupply system to digitally assign a unique vaccination number to every patient, track the cold chain of vaccines, track vaccine stock levels on a day-today basis, and provide a complete COVID-19 vaccination record for patients. These measures are particularly important in the remote outer islands where resources are limited.

“Part of why I love this role is the constant changes that come with trying to roll out a vaccine.”
– Georgia Lack

This excerpt is part of an article from the Indo-Pacific Centre for Health Security in celebration of International Day of Volunteers 2021. To read the full article, visit the website here.

Sunsets over endless horizons? Waving coconut palms and tropical fruit? Dolphins leaping into the air from crystal clear waters? Local fisherman in hand-carved canoes traversing a calm lagoon?

Ah, all those things. Oh and cyclones. And tsunamis, earthquakes, volcanoes, landslides, flash floods … and more cyclones.

I really do hate to spoil the romance but the beautiful countries that dot the Western Pacific really are among the highest risk in the world when it comes it natural disasters due to a cocktail of continental plate boundaries (which cause earthquakes) and a massive body of warm water (causing cyclones).

In the first three months of 2018 alone, the Pacific was hit by Cyclone Gita (striking Samoa, Tonga and southern Fiji), Cyclone Hola (striking Vanuatu), a continuation of volcanic eruptions on Ambae (Vanuatu) and a series of massive earthquakes in Papua New Guinea.

Pre and post disaster surveys in Tupaia MediTrak

These natural disasters impact everything: houses, water supplies, roads and electricity systems, individuals, schools, government services … and — often more critically — health facilities.

In disaster response, getting information to the right people as quickly as possible is absolutely critical. This is where Tupaia is helping.

Tupaia provides a map pinpointing every health facility across ten countries in the Pacific. When a disaster strikes, local and international response and recovery teams mobilise to assess the damage. These teams aim to restore critical services as quickly as possible — particularly medical care.

Tupaia is available to these response teams with a secure, online/offline data collection tool in Tupaia MediTrak, a free application for Android and iOS that can be used to assess and record damage. The app automatically pushes information to  a data aggregation and visualisation platform that displays what medical services and facilities are available or affected. Information can also be aggregated in real-time from disease surveillance platforms or weather apps. Where the recovery effort is likely to be drawn out, Tupaia functions as an essential tool in establishing what interim services are needed to cover the gaps.

In a disaster, network connection is hardly reliable, so Tupaia MediTrak allows response teams and health staff to collect data offline, which will sync when the mobile device comes back into range. As soon as Tupaia syncs, the data is made available to local disaster response coordinators, donors and experts around the world. Responders can even take photos within Tupaia MediTrak, which are then displayed on the website, providing an accurate representation of the situation on the ground.

Tupaia provides a clear picture of disaster affected facilities

The disaster module at tupaia.org presents an interactive map of health facilities, showing information about each facility, including their status in the wake of the disaster. Information can be viewed at the national level, the provincial level, and at the facility level, making it a useful tool for decision makers and responders at every level. Data is also secure, with powerful security features and the ability to grant permissions at a highly granular level so that different users need only access data relevant to them.

After Cyclone Gita struck Tongatapu in Tonga in February 2018, Tupaia was used to assess all health facilities in the wake of the huge storm. Within 48 hours, data had been collected from all seven facilities on the affected island. This could immediately be compared with baseline data collected several months earlier, so response teams could see how measures of water, electricity and available services were impacted by the cyclone. The Tupaia app also allowed pharmacy staff to take photos of the damage, which could be compared with photos taken at the baseline stage.

Live dashboards were made available to the Ministry of Health and incoming response teams from Australia and New Zealand and they were able to use that information to quickly plan their response and direct resources.

What’s more, this process ultimately saved money. The rapid assessments showed the damage to health facilities was, in fact, minimal and that resources should be directed towards communities and other public infrastructure (including water supplies) that had suffered much worse damage.

Tonga suffered widespread damage from Cyclone Gita in February 2018. Source: Reuters.

In Tonga, Tupaia helped maintain confidence in the health system and prevented an influx of unneeded medical teams and equipment. It might seem counterintuitive, but this certainly demonstrates that showing data on a lack of damage[1] can be just as valuable as showing the damage itself.

Unfortunately, the prevalence and intensity of a lot of natural disasters in the Pacific are set to worsen. For cyclones, this is as climate change accelerates and global sea temperatures rise. The impacts of landslides, earthquakes and tsunamis are also worsening, thanks to coastal erosion and deforestation in unstable, mountainous areas. More than ever, it’s crucial the region is prepared.

Here at Beyond Essential Systems, we’re continually working to improve the disaster response capabilities to make sure that only the most relevant and meaningful data is being collected (in emergency situations, asking meaningless questions can cost valuable time). We are aware many people  using tupaia.org post-disaster are accessing the website for the first time, so we are also working to make sure all maps and dashboards are clear and intuitive.

Check out tupaia.org and have a look for yourself. Cyclone Cyber is currently wreaking havoc on the fictitious country of Demo Land. While this is dreadful news for the equally fictitious inhabitants of Demo Land, it does provide a great chance for you to see the full disaster response functionality in action.

This resource is available to all Pacific Island countries for free. Let’s make the most of it for the benefit of the wonderful people who live there.

[1] Note: This is not to say that health facilities suffered no damage from Cyclone Gita but overall the buildings stood up to the Category 5 storm remarkably well — some smashed windows and minor water damage were noted, which could be appropriately triaged for when other issues had been addressed.

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

Initially commencing with the Reproductive Health section of the Ministry of Health, the Fanafala Ola project will continue to roll out digital health innovations for Non-Communicable Disease and Health Promotion, Community Health, Communicable Disease and Environmental Health sections throughout 2018. Central to the Fanafana Ola project is the adoption of a Tongan-led human-centred design approach to ensure the needs of the country are effectively met. As a part of this process, a Fanafana Ola Reproductive Health Super-Users Group has been established to guide all aspects of the planning, development and implementation of the digital health information system reporting tools and technologies that are to be adopted by the Reproductive Health section of the Ministry.

Key areas that have been identified to strengthen the Public Health System include the adoption of the tablet-based MediTrak application to support the rapid and digital reporting of essential routine health information; the adoption of the Tupaia web-based mapping and dashboard platform as a means to provide health personnel with readily available access to health information to support service delivery, decision making and workload management; and DHIS2 software as the backend system to be accessible by Ministry-based Health Information Systems staff. To date, the Fanafana Ola Reproductive Health Super-Users Group has reviewed all of their current Reproductive Health hard-copy based routine reporting forms, streamlined and developed these into a digital format, and are now currently guiding the design and development of innovative map and dashboard elements to be integrated into the Tupaia platform that are relevant to the specific needs of their program. As the subsequent health sections are rolled-out, relevant super-user groups will also be formed.

Tablet-based data reporting planning, design and development with members of the Fanafana Ola Reproductive Health Super-Users Group Siosaia Palavi, Nancy Tupou and Limisesi Kaivelata, and Beyond Essential counterpart Edwin Monk-Fromont (Photo Credit: Gerard Kelly)

Current reporting systems, including the late submission and the duplication of data, are some of the main challenges faced by Manafonu Siola’a, a Senior Reproductive Health Supervisor with the Tonga Ministry of Health. She says “Providing more accurate and reliable data in a timely manner and being able to easily identify some gaps and challenges to focus on and develop improvements are some of the ways the Fanafana Ola project will really help the Ministry”.

Lepeka Moala is a Reproductive Health Nurse from Kolonga Health Facility in Eastern Tongatapu and a member of the Fanafana Ola Reproductive Health Super-Users Group. “Having to manually document everything and mostly duplicating the same information, having to grab all books and documents when going on an outreach, and calculating and tallying of numbers are some of the biggest challenges in my work” Lepeka says. “I think the Fanafana Ola project will help reduce our workload, [provide] easy access and timing and supporting us so that we can perform a better health care service by looking at our shortcomings through the charts and dashboards. I am most looking forward to reporting and displaying [information] on the dashboards. Because I think this is a way forward for our work in every level and its just so exciting adapting new things”.

Fanafana Ola Reproductive Health Super-Users Group members Nancy Tupou, Manafonu Siola’a, Lepeka Moala, Melaia Belainausori, Siosaia Palavi discussing planning and development with Beyond Essential counterpart Gerard Kelly. (Photo Credit: Nancy Tupou)

The Fanafana Ola Public Health Digitization Project presents an exciting development for not only the Kingdom of Tonga, but also paves a way for demonstrating how the adaptation of digital technologies and innovation through a country-led human-centred design approach can strengthen health systems throughout the Pacific Region.

Tupaia is proud to be working with project partners Gevity Consulting to deliver Fanafana Ola for the Ministry of Health for the Kingdom of Tonga.

We call it Fanfana Ola – check it out here.