As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
An innovative distribution system addressing supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators
Government of Senegal: Ministère de la Santé et de l’Action Sociale (MSAS) - Ministry of Health / Pharmacie Nationale d’Approvisionnement (PNA) - National Supply Pharmacy
Merck for Mothers
Bill & Melinda Gates Foundation
1,466 facilities and 1,627 health workers in all 14 regions of Senegal
2013: Intrahealth and Dimagi implemented the Informed Push Model (IPM) project with the MSAS and PNA to expand access to 40 family planning products.
2017: IPM system deployed on a large scale,ie accepted at the national level by the MSAS and the PNA and extended to 118 essential drugs.
2018: Dimagi began transferring the program and technology to the PNA for national ownership
Health Care Provider, Health System Manager, Data Services Provider
Leadership and Governance, Strategy and Investment, Legislation, Policy, and Compliance, Services and Applications, Standards and Interoperability, Infrastructure, Workforce, Integration and Sustainability
Senegal’s government has pledged to reduce contraceptive stockouts, which have been frequent for years in public health facilities. Lack of quality/reliable data and insufficient utilization of data are major health system challenges that led to the introduction of an innovative distribution system called the Informed Push Model (IPM) or Yeksi-Naa (“I arrived” in the Wolof language) system, addressing supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators. The Yeksi-Naa system informs a push model of supply chain management in targeted health facilities.
In 2013, IntraHealth International, in collaboration with the Ministry of Health (Ministry), National Supply Pharmacy (PNA), and Dimagi, started expanding access to—and use of—family planning by reducing contraceptive stockouts by implementing the IPM. The model made available a wide range of family planning commodities—initially around 40— allowing women to freely choose the methods they want at affordable prices.
Following promising pilot results, the Ministry of Health committed to a three-year expansion of IPM to all public health facilities nationwide, reaching nearly 1,400 facilities by the end of 2016. Today, the Yeksi-Naa system has scaled nationally to improve the family planning supply chain in Senegal’s public sector and even extended to 118 essential drugs.
IntraHealth and Dimagi have worked together to develop and deploy an electronic Logistics Information Management System (eLMIS) using CommCare applications for the management of all family planning commodities in 1,400 facilities across Senegal.
In this deployment, mobile logistics operators equipped with commodities travel to each facility to perform inventory management tasks, track indicators, and deliver commodities on the spot. Each logistics operator delivering supplies to points of sale on a regular schedule is equipped with a tablet running CommCare, which allows them to easily record, manage, and review stock information for hundreds of facilities, ensuring that each site and warehouse is sufficiently stocked, and allowing manufacturers to keep pace with demand, taking the burden of tracking and ordering inventory off of pharmacies and clinics.
The system is tracking real-time facility-level data and making them available through a series of costumed dashboards at the district, regional, and national levels —allowing for improved supply forecasting.
Moving from paper to the eLMIS enabled stronger forecasting and tracking. Logisticians can use historical data to estimate the amount of product each clinic needs and can adjust this amount based on a number of variables, including climate conditions, fluctuations in nationwide health trends, and regional or local factors.
Over two years, IntraHealth partnered with Dimagi to support transfer of technology to the National Supply Pharmacy (PNA). This included training of trainers on the CommCare application; management of the back-end application creation platform, CommCareHQ, in which new hierarchies and location products can be added; and assisting the National Supply Pharmacy to define standard processes for deployment, troubleshooting, and data management.
After Senegal’s national digital health strategy was established, Dimagi and the National Supply Pharmacy created a local server within the National Supply Pharmacy, based on PNA-defined capabilities and infrastructure requirements, where the CommCare solution and data are hosted and managed independently by the National Supply Pharmacy. The instant transfer of data from districts and regions helps ensure that information captured from facilities aligns with that recorded at the national level and can be used to regularly report on trends and track progress toward global and national targets
The Yeksi-Naa system has succeeded in transforming the supply chain system in Senegal thanks to an improved design of the system passing from traction to push, to an outsourced distribution from the public to 3PL, to better visibility data from paper to Android tablets (using CommCare), and increased financial sustainability moving from initial payments to post-consumer payments in healthcare facilities.