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.
The information below appeared in the original case study.
Integra Health Nigeria
Integra Health Nigeria
Integra Health Nigeria
Health System Manager
Services and Applications
Supply Chain Management
This case study was originally published in the mHealth Compendium Volume 5, developed by the African Strategies for Health project, implemented by Management Sciences for Health with support from the U.S. Agency for International Development (USAID). Updates to the original case study appear in the final section of this case study.
The Nigerian healthcare market is characterized by an abundance of substandard, counterfeit drugs. In 2001, it was estimated that about 50 percent of all drugs within the market were fake. This rate is said to have fallen over the next five years by about 80 percent following aggressive action by the Nigerian National Agency for Food and Drug Administration and Control (NAFDAC).
This problem is further exacerbated by a fragmented drug system, where health providers often purchase from multiple wholesalers, directly from manufacturers, and from open air drug markets simultaneously. This system leads to inefficiencies in the drug market, where prices are incomparable and opaque, and where health providers are unable to certify the quality of the drugs bought in the open drug markets or from unscrupulous distributors of drugs. No collated database exists that allows hospitals to view all available brand variations and make purchasing decisions based on the right pricing for their market. As a result of this fragmented system, prices often change sporadically and variety is limited to the health provider’s exposure to products they are familiar with. To put this in context, average drug prices in Nigeria range from two to 64 times the international prices in both private and public health facilities, according to a recent UNIDO report on the Nigerian pharmaceutical sector.
DrugStoc is a hybrid between an eCommerce website, a desktop application, an Android application, and a networked chain of GPRS/SMS-enabled Android printers working in tandem to (1) eliminate reliance of medical facilities on the open air market for drug purchasing; (2) consolidate the drug supply commodity chain increasing the barrier of entry for substandard products; (3) improve the profitability of hospitals and the pharmaceutical industry by translating efficiency gains into monetary profit; and (4) build a database of location-based live pricing for drugs, consumables, and medical equipment in Nigeria.
DrugStoc launched its Beta site in 2015 at the co-creation hub in Yaba, Lagos. It was attended by the Director of Pharmacovigilance at NAFDAC as well as other relevant stakeholders.
With its picturesque, easy to use, and touch screen-adaptable features, DrugStoc can be used by any type of facility or individual with minimum training. Support call centers are manned by staff who can help facilities place and manage their orders. DrugStoc also offers a low-tech alternative for health facilities that are not connected to the Internet or which have poor computing infrastructure. This comes in the form of a catalog with designated operator codes which are linked to commodities on DrugStoc. These codes can be used to check for prices and place orders using the Android app, text messages, or the DrugStoc call center.
Qualitative questionnaires were distributed among hospitals and pharmacies in Lagos State, Nigeria, while focus groups were conducted with health facility owners, procurement officers, and pharmacists. A limited Version 1.1 of DrugStoc was introduced in 12 facilities that completed the questionnaire. The key findings related to the efficiency in timing, pricing, and orders.
Fragmented ordering and the use of multiple sources for the same drug item was noted. Preliminary results from the closed pilot indicate a 94 percent average reduction of time spent ordering and managing supplies observed when the facility used Version 1.1 of DrugStoc to place orders. Price efficiency was also tracked: most facilities kept handwritten notes on the last purchase price of a drug item. Purchase price changes were sporadic and supplier dependent with the facility being informed about the price change during the re-ordering process. No maximum retail price (MRP) was observed with multiple suppliers offering the same drug item at a different price.
Finally, order supply time can vary between suppliers and is dependent on a distributor’s logistical capabilities, the distance from the supplier, and the monetary value of the items supplied. Item stock outs among suppliers were also noted, forcing facilities to look for alternative suppliers or asking the supplier to send an alternative brand within the same price range. All these factors reduce the efficiency and reliability of medicines orders, which DrugStoc aims to improve.
DrugStoc is an innovative hybrid online/offline drug distribution and inventory management solution that creates an efficient drug supply chain for health facilities while reducing order time, enhancing purchasing power, and significantly reducing the risk of purchasing counterfeit or substandard products.
Today, DrugStoc continues to support Nigeria’s health sector by providing an anticounterfeit pharmaceutical procurement platform for health workers to source needed medications, consumables, and small medical devices. DrugStoc supports the Procure Direct app, which provides the following capabilities to health workers:
DrugStoc was awarded the Technology-Driven Distributor Company of the Year Award in the 2019 Nigerian Healthcare Excellence Awards. The same year, DrugStoc received investment funding from Growth Capital, a Nigerian-based cocreation hub innovation fund.
“Nigerian Healthtech DrugStoc Secures Investment from Growth Capital,” Venture Burn, June 28, 2019, https://ventureburn.com/2019/06/growth-capital-drugstoc-investment/.
DrugStoc (website), https://www.drugstoc.com/.
Note: this project update was produced by PRB based on the resource and reference listed above.