This post is an exploration of how we’re evaluating digital health supply chain management systems, and what we’re not getting right.

Firstly, let’s be clear about what we’re trying to achieve. 

Let’s define the outcome we want to see: Sruthi has started labour contractions, but they haven’t progressed, and now she needs to be administered Oxytocin. She has presented to a small health centre in her village. The Health Care assistant opens the medicine fridge to get the Oxytocin. Will she find any? If she does, will it work as intended? 
That’s our job right there – to make sure that behind that fridge door there’s the thing that’s needed, and it’s effective at saving the life of Sruthi and her baby.

That’s an effective intervention, and our job is to get as many of them as we can, given the budget that we have to work with.

But often that fridge gets opened, and it’s not good news for anyone. Not only that, no one knew that the Oxytocin had run out (or expired). No one knows how much is on order. No one knows how much is in stock at the higher levels of the supply chain, and on and on….

And of course, along comes a donor who thinks that digitising the system would solve many of the above problems.
Well, at least it could.

Before an organisation setting up a supply chain in a high income country starts work, then don’t ask “should we use paper, or should we use a digital system.” The benefits are glaringly self evident.
But in low & middle income countries, the question is far from settled. And amazingly, considering there are literally tens of billions of dollars flowing through government health supply chains, there is not one randomized controlled trial testing the hypothesis that digitising systems makes a difference. Not one.

So we have an information vacuum. And what we get in it’s place is a combination of approaches from “give us the cheapest software” through to detailed assessments by well meaning consultants concluding that if we apply (High income country) best practice we’ll get the same outcomes we get in high income countries. If only!

Soooo, that’s the lay of the land – we have some unanswered questions to investigate.

Our Journey

You may well ask “after 20-something years of doing this, you’re only saying this now?”

Fair enough. We’ve been on a journey. In the last few years we’ve had something of a revelation about this (thanks Rob & Amy!).

To travel backwards a bit: At the start, we’d seen software make a big difference in a store in a low-income country, and seen other stores and pharmacies have the same impressive results.

We assumed that just making the software more widely available, and making it meet the needs of each country would be enough. Not so! Sometimes it worked well enough that both a country and donors loved it. Sometimes it clearly didn’t.

Tolstoy’s “All unhappy families are unhappy in their own way” gets quoted too often, but the point is a good one: so many ways to fail! Only by addressing all these factors can we move the dial on medicine availability, and do so in a way that is worth the investment of time and money.

So, we’re reformed. We’re staying laser focused on effectiveness. We’ll be writing a bit more in the coming weeks to unpack what effectiveness means, especially when it comes to open source software, true cost-effectiveness, and a whole lot more.

The second part in our series is now live – Outing Net Outcomes