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

This is why we developed the Immunisation Dashboard in the Tupaia app and launched it in Vanuatu this year.

Watch our video

Sounds simple, right? In many of the small island nations where we work access to a reliable power source, a working fridge and accurate fridge temperature monitoring, quality assurance can be a big problem.

This is why we developed the Immunisation Dashboard in the Tupaia app and launched it in Vanuatu this year.

[dt_highlight color=”” text_color=”” bg_color=””]Watch the video below to hear the full story.[/dt_highlight]

How it works?

Our immunisation dashboard automates daily fridge temperature reports using Bluetooth sensor technology and mSupply mobile. It’s designed to help national and regional health workers and managers access real-time information about what vaccine supplies are in-stock, how they are stored and if they are safe for use, all in one place.

Reports are available offline and the sensor records the highest and lowest temperature of the vaccine fridge each day, and the ideal temperature is from 2 and 8 degrees celsius. Anything above or below is classed as a breach.

The challenge

The journey of a vaccine from manufacture to a health facility on a small remote island, then to the patient, is a long one that takes time and money. This is why it’s so important they are stored effectively to avoid the need to replace vaccination supplies and equipment, all together.

Previously, accessing this information instantly and in one place has not been possible. It was administered manually using paper-based reports and different health information systems that need to be written, dispatched and interpreted.

In June 2019, the nurse working at Amauri Dispensary on Lelepa island, Risco, detected that the fridge temperatures were too high alerting staff to a fridge malfunction.

This temperature information was sent to regional and national health centres, where managers from the Expanded Programme on Immunisation and Ministry of Health could review the data instantly, and make a plan to resolve issue.

Caption: this is what a consistent temperature breach looks like. As you can see, the fridge at Amauri Clinic was repaired on 10 October 2019.

The solution

We installed Bluetooth fridge sensors at 8 health facilities in Vanuatu’s Shefa Province to automating fridge temperature tracking in June 2019.

Health workers at each clinic learned how to sync fridge data from the Bluetooth sensor to mSupply mobile to send data and interpret data within the Tupaia app. Now they can instantly see is the fridge working? Is the temperature too low or too high? What is the problem and how long has there been one?

With Tupaia, the fridge temperatures and supplies available at each clinic can be viewed anywhere, anytime, to check that vaccines are kept at the right temperature and are safe and effective for the people receiving them.

Without this oversight vaccination equipment can break and vaccines spoil and they are not easy to replace. Besides keeping vaccines cool and safe, the Immunisation Dashboard allow health workers, suppliers and decision makers to visualise immunisation data in real-time to detect problem areas quickly and proactively solve the problem.

Before	After
Daily paper-based reports recorded manually using a thermometer.	Hundreds of automated Bluetooth data reports viewed in one report.

This project began back in April 2018, when mSupply Mobile tablets were first installed at 7 health facilities around Efate. mSupply Mobile enables electronic management, tracking and ordering of medicines. Under our Gates Foundation grant, we have worked with mSupply to build a vaccines module in mSupply Mobile and in addition to this, we are collecting live fridge temperatures, facility surveys and vaccine coverage information, compiling all of the data in Tupaia. Previously, accessing this information in one place has not been possible, as it has been administered manually using numerous methods and health information systems.

To collect immunisation data at each of the health facilities and successfully introduce new mobile reporting tools, we’ve been working with public health managers, health administrators and zone supervisers, the Expanded Program on Immunisation (EPI) Pharmacy Division, Health Information Systems unit and Shefa provincial health teams within the Vanuatu Ministry of Health.

A crucial factor when it comes to administering immunisation medicines effectively, is being able to quickly find out what and where supplies exist and if there are any stock outs of vaccines at specific health facilities. Now that this information can be accessed in real-time, time delays can be reduced and immunisation supply chain systems can be strengthened through powerful data integration via DHIS2 software. 

Another win for health facilities and health workers in the Shefa province is the addition of automated fridge temperature tracking fridge devices, which allow temperature information to be monitored and tracked within the Tupaia dashboard. This means national and provincial health workers can see live information for individual health facilities via the Tupaia dashboard (see below) and take action if there are any persistent temperature breaches.  

To support the roll out of the Immunisation Dashboard our Vanuatu Program Manager, Sera Ngeh facilitated a three day workshop this month in Port Vila, with Results for Development (R4D) who are conducting the monitoring and evaluation for this project, using a process called Adaptive Learning. We’re proud to be working with R4D who have partnered with us thanks to support from DFAT’s innovationXchange. National and provincial managers and health facility staff from the Ministry of Health attended the workshop, along with lead software developers from Tupaia and mSupply. Baseline interviews and follow-up survey data that was collected by R4D and local researchers from March to June this year was presented during the workshop for discussion and action planning. These baseline surveys covered areas on the immunisation supply chain, reporting data and workflows as well as current immunisation barriers in Vanuatu.  

We will continue to support health workers at a national, provincial and health facility level understand and use mSupply Mobile for their medical and vaccine stock management and ordering and increase digital literacy around the use of this technology to improve immunisation coverage in Vanuatu. 

Whilst access to the immunisation module is password-protected, if you would like a live demo, please don’t hesitate to get in contact. To check out the other features in Tupaia for yourself, log into www.tupaia.org and explore the data. 

This project was developed in partnership with mSupply (Sustainable Solutions), with funding from the Gates Foundation, innovationXchange and the DFAT Indo-Pacific Centre for Health Security. 

From left to right: Sera (Tupaia), Erin (R4D), Risco (Nurse Amauri Dispensary), Janet (Shefa EPI/MCH Manager), Jenny (Nurse Leimarowia), Kalwat (Zone 1 Supervisor), Jocelin (Midwife Maurifanga Health Center), Agnes (Acting Principal Pharmacist), Andrei (mSupply), Dr Thyna (VCH Paediatrician), Rex (Nurse Saupia Health Center), Amy (JiCA), Andrew (R4D), Luke (R4D), Chrisilla (MCH clinic), Blaise (National EPI Officer), Laurel (R4D), Bastien (Tupaia), Edwin (Tupaia), and Morris (Shefa Provincial Administrator).

www.medqualityassurance.org