Customization of Real-Time System through Local Mobile Networks to enhance NFIs and Health & Nutrition Supply Chain in IDPs and Health centers.
by Elsheikh Abdul Bagi Soheib
Introduction
Sudan has been making significant progress in maternal and child health these years, yet it is still far to achieve the global target. The Ministry of Health has launched “Five in Ten” strategy: Reproductive, Mother, Neonate, Child Health and Adolescent (RMNCHA) Strategic Plan 2016-2020 in October 2016 to operationalize the government commitment to be accountable for the improvement of maternal and child health.
This strategy directs to strengthen information databases that would ‘guide policy making; leadership and stewardship at the various levels of the health system; health financing to translate the commitments into actual monetary support; and ensuring the provision of full service package for women and children across the country’ (Five in Ten strategy, page 38). The importance of evidence generation is also stated as a leverage for the better decision-making on health policies and investments. The assessment method of the availability and quality of RMNCHA services at health facilities will be also explored during these five years.
UNICEF has been introducing globally innovative solutions for maternal and child health. One of the most common solutions applied in many countries is a mobile technology, called RapidPro. It was built by UNICEF with the collaboration of a Rwandan software firm, Nyaruka. RapidPro is a platform to build scalable mobile-based applications and powers to connect government leaders and the important information sources. It provides a workspace that allows to build message flows while setting triggers for executing them, manage user profiles and dynamically group them, analyze responses, and build campaigns that automate the engagement with users based on their responses.
Objectives
By applying RapidPro into the information system of the Ministry of Health, it enables;
- To monitor sufficient and timely delivery of health support for mothers and children
- To strengthen the national capacity of monitoring
- To hold accountability to stakeholders, partners, and donors.
Overview of the RapidPro system
RapidPro can establish a two-way communication system among the Federal, State and Locality Ministry of Health, referral hospitals and health facilities in Sudan. By integrating RapidPro into the existing health information management system, it enables to have the system updated with real-time information: supply and service delivery, stock-out and status of indicators to be monitored.
Possible entry points to build the integrated system with RapidPro will be as follows;
Health and nutrition supply chain monitoring
The National Medical Supplies Fund (NMSF) has developed its supply chain system to manage an inventory of more than 900 items, mostly for the Free Under-Five drugs. 17 out of 18 states have warehouses controlled by State Medical Supplies Fund. Yet, some key items for maternal and child health are not included in the NMSF-managed inventory, such as items for nutrition, reproductive health, and vaccines. The NMSF’s digital supply chain monitoring system covers above the state level. At health facility level, implementation site personnel record their stock balances on paper forms and send these through the State Ministry of Health who compile at a state level and send to the Federal Ministry of Health for national compilation.
The initial stage of deployment will focus on 10 items categorized as the first priority (Plumpy Nut, F100, F75, ORS, Zinc, Vitamin A, IV fluid, Fefol capsules, Misoprostol, Magnesium) to be monitored at Health Facility and Referral Hospital level. The monitored items are mainly nutrition items and drugs provided by UNFPA, which are not currently monitored by the NMSF.
By adding RapidPro to the existing NMSF’s system, it will enable to send the regular stock data in real time to the Supply Management teams of the State and Federal Ministry of Health from health facilities and referral hospitals. The application will track the current stocks data in implementation sites at the health facility, and referral hospital levels. The implementation site personnel will be responsible to regularly send the stock reports as they do currently.
In addition, the RapidPro system can also be used to monitor vaccine stock-out by health facilities where immunization services are available. It will ensure an adequate supply of vaccines and accurate delivery of immunization services.
Update of the cold chain inventory
The Expanded Programme on Immunization (EPI) started in Sudan in 1976 and it has expanded gradually to cover all the current 187 localities. UNICEF has been the major provider of cold chain equipment for the EPI and especially in the last 5-6 years, has been working very closely with the EPI in its cold chain expansion and rehabilitation in addition to the support of the capacity building of its cold chain technicians.
It is crucial for all the partners working in immunization to have a real-time monitoring system and update on the cold chain status for a timely intervention and enhancing the effective vaccine management. In 2016, UNICEF in collaboration with the Ministry of Health and Gavi has undergone a mobile-based cold chain inventory survey. After its completion, it is necessary to keep the inventory updated in case of new installations. The RapidPro system can be established to feed the up-to-date information into the current inventory. Health facilities which have installed new equipment can report the necessary information by RapidPro.
Budget
The cost of the RapidPro system consists of two-fold: messages and supporting costs. The cost of messages can be estimated based on the scale of outreach and frequency of communications through text messages. The supporting costs include RapidPro setup, customized dashboards, hosting servers, staffing cost, and deployment training cost.
Messages cost
In order to estimate the cost of messages, an offer for bulk SMS from one of the Sudanese companies (as of May 2016) is used.
It is recommended that the Ministry of Health will negotiate with the major Mobile Network Operators (MNOs) in Sudan (Sudani, Zain, MTN) to reduce the messages cost. Upon successful negotiation, the inbound and outbound SMSs could be provided through a Pro Bono agreement or a bulk SMS (special SIM optimized for a discounted rate for sending and receiving SMS, cannot be used for phone calls) arrangement with the provider and /or related organization.
Infrastructure and Support Costs
Hosting options
RapidPro can be hosted on servers locally or in the cloud. Running the RapidPro platform without experienced RapidPro service providers requires the expertise to run, maintain and keep all the software up to date in a secure, high availability data center, and the ability to acquire and maintain web and database servers and load balancers.
There are three options for hosting servers: cloud, in-country, and third-party. Each option has different features and costs.
Cloud server
The RapidPro system consists of a hosted server with 24 hours / 7 days a week access to electricity and the internet. It is powered by Amazon Web Services (AWS) and is maintained by UNICEF Global Innovation Centre and its hosting vendor. The hosting environment uses state-of-the-art, industry-standard security and is constantly monitored by UNICEF Global Innovation Centre staff, hosting vendor staff, and Amazon Web Services staff. AWS is compliant with numerous security and privacy standards, including HIPAA, ISO 27001, and many more.
Access to data saved in the online server can be configured by administrators designated by the UNICEF Country Office. Technically, the Global LTA vendor and hosting provider could access the data but are contractually bound by the Data Protection Provision (see Annex I) to refrain from viewing or copying any Country Office data without consent. A few white papers from Amazon Web Services related to data security at https://aws.amazon.com/whitepapers/. This online server is the most recommended by UNICEF Global Innovation Centre as the most cost-effective and reliable hosting option.
In-Country Hosting
This option requires the most active management given it passes a feasibility assessment for the hosting environment, along with procuring and configuring a network, hardware and software resources. A dedicated staff that is trained for system maintenance, backup and restoration and a part-time system administrator will also need to be hired.
This option will provide you with maximum flexibility to manage and maintain the environment your applications sit on, however, does not guarantee better performance or security outcomes. Without daily management and monitoring of the environment and proactive responses to security/performance vulnerabilities, this option can run the risk of sub-par performance and data security vulnerabilities. The overhead for this option is extremely high.
In case of choosing the in-country hosting option for RapidPro, feasibility assessment should be conducted possibly for the servers where the RapidPro system will be installed.
The cost varies depending on a scope of the desired system and the availability and cost of resources in Sudan. The average cost indicated by the UNICEF Global Innovation Center is as follows:
|
Items |
Cost (USD$) |
|
Set-up Cost |
$75,000 |
|
quarterly maintenance |
$120,000/year |
|
systems administrator |
unknown |
|
hosting vendor |
unknown |
|
internet connections |
unknown |
|
feasibility assessment |
unknown |
Third-Party Hosting
RapidPro is open source software, so it is possible to choose any vendor to install, configure, host, and support the RapidPro deployment, although the UNICEF Innovation Centre will not be able to be involved in the monitoring, updating, or management of the RapidPro deployment, nor can it guarantee better performance or security outcomes. Frequent maintenance and updates by dedicated technical staff will still need to be performed. Furthermore, performance and data security levels will depend on the vendor’s hosting facility and reliability in connectivity. Additional data security provisions might have to be negotiated with the carrier in order to protect information collected from your applications.
The rough cost estimate from one of IT companies in Khartoum is as follows:
|
Items |
Cost (USD$) |
Remark |
|
RapidPro setup at Government Data Center |
Cost unknown |
Operation size + type of access we will have to this server greatly affects cost |
|
RapidPro hosting (cloud hosting - UK based data center | 99% uptime | automatic backups) |
600$/Year |
Technical specs of the server (4 cores CPU | 8GB RAM | 96 GB SSD HDD | 4TB Transfer | Network: IN 40GBbs / OUT 500MBbs ) |
|
RapidPro Activation (setup and configuration of the platform | SMS integration | without dashboard customization) |
3,200$ |
More specs are needed to provide a cost estimate for customization task. |
|
RapidPro Technical Support (email/phone support (during working days and hours), Up-to 10 users) |
3,000$/Year |
More premium technical support offer could be provided if needed (24/7 support | SLA) |
|
Customized dashboard |
Cost unknown |
More specs are needed to provide a cost estimate for customization task. |
Shortcode
The SMSs are sent to the database via a toll-free number (reversed-bill shortcode). Licensed shortcodes need to be obtained from the National Telecommunication Corporation and registered into telecommunication companies in Sudan.
The reversed-bill shortcode will never cost the reporters using the RapidPro system. It is necessary to identify an aggregator to enable to have the same shortcode on all mobile networks. Aggregators have relationships with MNOs and can procure the same shortcode on all networks on behalf of the Government or UNICEF. This may cost purchase fee for the shortcode and annual fee depending on countries. The cost of obtaining a shortcode is estimated by one of local IT companies for 1,000 US$, and 400$ for the annual renewal of license.
Other costs
The following costs need to be considered for the actual deployment of RapidPro:
- Staffing cost: In case of hiring a national consultant who will be closely working with the Ministry of Health to deploy RapidPro
- Deployment training cost: The cost will depend on the way of organizing the training.
Total amount of cost
The estimated total cost in case of selecting a cloud server option (Ilhasoft), but except staffing and training costs is;
For the first year
Message cost (10,327.18$) + Supporting cost (25,200$+1,000$ x 4 short codes) = 39,527.18$
After the second year (annual cost)
Message cost (10,327.18$) + Supporting cost (6,000$+400$ x 4 short codes) = 17,927.18 $
If you want to learn more from this executive summary, send us an email to mashlm@usi.ch requesting the full thesis.
