What you need to know:
- Hospitals say the app has reduced the workload on health workers.
- The QualiPharm tool has an in-built data validation rule and a multilevel review and approval process.
- It gives alerts for overstocking, wrong entries and irrational orders at the county and sub-county facilities.
For years, Maurice Wario has been traveling for 300km every month from Dadacha Basa dispensary to Isiolo Referral Hospital to manually submit paperwork on health indicators, including family planning.
His journey takes at least three days before he reaches his destination to submit the numbers, which would later be manually reported to the central place.
He spends about Sh5,000 on transport and accommodation per day, before picking his daily allowance from the county.
With this system, it was easy for the health workers to make mistakes in their reporting. Because of the distance from one facility to the other, most of the workers were reporting the data late hence interfering with planning and consignment orders.
With the manual filling of the papers, it was not easy for the county’s health management to know what family planning commodities were out of stock on time, which facilities were overstocked and which ones were understocked.
This has since forced many women in need of the commodities to go without them, with some facilities having only one commodity and others going without them for months.
However, with the development of QualiPharm by the United Nations Population Fund (UNFPA) in partnership with Health Strat, these challenges might become a thing of the past. The mobile-based reporting tool tracks consumption of family planning commodities in hospitals at the county and sub-county level.
The tool that has since been introduced in the six counties of Isiolo, Homa Bay, Migori, Kilifi, Marsabit and Nairobi, ensures that facilities are well stocked while reducing instances of poor data quality and delays in reporting.
Averting stock outs
Health workers are now able to key in their numbers everyday after taking stock of the commodities. By the end of the month, all the facilities have submitted their data, which helps the counties in early planning and monitoring.
Hospitals also say the app has reduced the workload on health workers.
Charity Koronya, a reproductive health commodity security specialist at UNFPA, says they came up with the idea after an assessment to understand stock outs of commodities.
“After doing the assessment we noticed that one reason for the delay of procurement of commodities was lack of appropriate data. Data is also reported very late, hence delays in decision making,” adds Koronya.
The app, that is being used in 400 facilities in the country, cost approximately US$600,000 (Sh65 million) with the tablets costing US$250,000.
The app was developed through digitisation of the manual Facility Consumption Data Reporting and Requesting (FCDRR) tool. FCDRR is used by health workers to report data on medicine for specific programmes such as family planning, malaria, HIV and tuberculosis.
The end result of the digitised process is the availability to have timely and accurate family planning commodity data. The data is then used to come up with rational orders, thus averting stock outs. This ensures uninterrupted supply of family planning commodities.
Through QualiPharm, the amount and quality of data going into the Kenya Health Information System (KHIS) such as quantities received, quantities consumed and ending balances of each product at the sub-county level has increased. “Using this information, we are able to monitor the stock status of each commodity at the end of each reporting month hence increasing the visibility of available stocks in the facilities, which help to inform decision making such as redistribution of commodities,” says Wario.
Wario, who benefited from the training on how to use the mobile app, tells HealthyNation that with the app, he does not have to travel to Isiolo to submit the data instead does the entry every day and every month transmits it to the central point. “It makes my work easier. I do not have to travel and at the same time, it is cost-effective and saves time. In addition, there is no repetition,” he says.
He confesses to HealthyNation that three years ago, he lost the papers on which he had recorded the data and it almost cost him his job. Luckily, he had photocopies of the reports.
Dr Peter Ngugi, a pharmacist in charge of Isiolo Sub-county, says with the app, they are able to calculate what each facility is using, consumption of each commodity which facility has more than it needs and which one has less.
“This app informs the distribution pattern of the commodities, enabling real-time decision making with an increase in the uptake of family planning,” says Dr Ngugi.
Before, they would do 22 reports each. “You can imagine the kind of work that I need to do while electronically sending the numbers from the 18 facilities and each person is sending 22 reports. With the app, it is so easy. They are directly keyed in from the facility and it comes directly to the portal. My work is just to verify the data. It is now a day’s work while before I would even take a month before transmitting the reports,” he says.
He tells HealthyNation the app has also enabled them to distribute the commodities according to the patient’s preference in all the facilities.
“For instance, if we notice that a particular commodity is in high demand in a particular facility, we purchase more of that and reduce the number of the ones that are underused,” he adds.
He says he is able to tell from the app which facilities have submitted and which ones are yet to while also noticing which ones have a mistake and need to be corrected.
“When the app shows red, it means that no report has been submitted. But when it turns green, it means everything has been submitted and the report has no mistakes,” says the pharmacist.
The QualiPharm tool has an in-built data validation rule and a multilevel review and approval process which gives alerts for overstocking, wrong entries and irrational orders at the county and sub-county facilities.
This has enabled the officers at the facilities to report accurate consumption data while addressing actual needs hence reduce wastage of resources and avert stockouts and loss through expiries. The app has also led to an increase in the uptake of the family planning commodities in most facilities in the six counties because most of the facilities are well equipped.
However, with the emergence of the innovation, Rachel Gisoyo, a beneficiary, says she has never gone to any hospital in Ibuya Village and missed her preferred method.
“Nowadays I am not worried about getting pregnant because I can access my five-year family planning method unlike before when you could only get the pills, which is a three-month method. There is no stockout, thanks to the app,” she tells HealthyNation at her home in Isiolo County.
Koronya says they are planning to roll out the app in six other counties and later in all the 47 counties. This will help in timely and quality data collection, she says..“Once the commodities are available in the facilities, clients get all the methods they want. This is going to increase access to services,” she adds.
Before the app, a survey done by the Performance Monitoring Action (PMA) in Kenya revealed that most public hospitals fail to stock family planning commodities, leading to an increase in unintended pregnancies.
Most hospitals ordered the supplies but did not receive them because of logistical and payment issues. This led to a decrease in the number of women using family planning methods from 30 to 21 per cent on short-term methods, and the high rate of unintended pregnancies that stands at 44 per cent, the survey revealed.
The data, collected in 11 counties between November and December last year, also revealed there was a huge disconnect between the desire to use a family planning method and the availability in terms of access, and this put the women at risk of becoming pregnant.
A review of the data by the PMA phase 1 results revealed that out of the 784 public hospitals, 86 per cent of facilities ordered for the implant but did not receive shipment. Additionally, 86 per cent did not receive injectables, 80 per cent did not receive pills, 66 per cent did not get IUDs and 68 facilities ordered for male condoms but did not receive them.
The implant was found to be the most preferred method of contraception among married users, with usage significantly increasing from 20 per cent in 2014 to 41 per cent in 2019.
It is, therefore, no surprise that one in 10 public health facilities did not provide at least three modern contraceptive options in 2019 as shown by the survey.
In Kenya, as in many other African countries, sustainable and prosperous families have been the aim of a strong family planning drive, grounded on the constitutional right of access to health services, including reproductive healthcare.
Kenya has the lowest fertility rate per woman in the East African community (3.7), according to "The Power of Choice: Reproductive Rights and Demographic Transition" report by the UNFPA. This is a drop from 4.4 in 2012.
Preliminary results from the 2019 census show that the average annual population growth rate dropped to 2.2 per cent from 2.9 per cent a decade ago, and the average household size also dropped to 3.9 from 4.2 in the same period.