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Project Title: Vaccine Stock Management Tool

By

Student No: 067709

An Information Systems Project Documentation Submitted to the Faculty of Information

Technology in partial fulfilment of the requirements for the award of a Degree in Bachelor of

Business Information Technology

Submission Date: 22nd March 2016

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Abstract

The Division of Vaccine and Immunization is facing increasing difficulty monitoring vaccines

and other commodities distribution once they have been distributed from the national stores.

With the introduction of new vaccines, more challenges have been anticipated with this

additions posing serious threat to the already over strained vaccine supply chain system in

Kenya. Access to these vaccines will have surpassed the current ability of the existing supply

and logistic system to distribute, track and store the vaccines at proper temperatures, condition

and quality and ensure they reach their destinations in a timely manner.

This paper is a system documentation for the development of Vaccine Stock Management Tool

for the Division of Vaccine and Immunization of Kenya. The study was conducted to research,

study and review existing literature and systems architecture for vaccine stock supply

management and studied the existing vaccine supply management system in use in Kenya. This

revealed the current inefficiencies in vaccine supply and stock management within the Division

of Vaccine and Immunization department in the Ministry of Health. The result of the study

were the design and implementation of a vaccine stock management tool that would address

the frequent levels of stock outs in the country by introducing a system based on a “push” or

requisition model rather than the “push” or allocation approach currently been used.

To achieve this, a web-based vaccine stock management tool was developed following the agile

methodology. The developed solution is an implementation of a vaccine supply chain and cold

chain management system that ensures efficient and effective vaccine delivery and that enable

better and timely decision-making. Availability of quality, real time data on vaccine supply and

demand at the national, regional, and lower levels would be critical to supporting improved

efficiencies in how vaccines are managed in Kenya.

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Declaration

I hereby affirm that this system documentation document is duly my original work and

therefore has not been submitted in any institution for the satisfaction of any academic award.

Student Signature: ___________________________ Date: ________________________

Supervisor Signature: ________________________ Date: ________________________

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Table of Contents

Abstract ...................................................................................................................................... ii

Declaration ............................................................................................................................... iii

Table of Contents ...................................................................................................................... iv

List of Figures ...................................................................................................................... vii

List of Tables ...................................................................................................................... viii

Abbreviations ........................................................................................................................ ix

1 Chapter One: Introduction ................................................................................................ 10

1.1 Background of the Study ........................................................................................... 10

1.2 Problem Statement .................................................................................................... 12

1.3 General Objective ...................................................................................................... 12

1.4 Specific Objectives .................................................................................................... 13

1.5 Justification ............................................................................................................... 13

1.6 Scope ......................................................................................................................... 14

2 Chapter Two: Literature Review ..................................................................................... 15

2.1 Introduction ............................................................................................................... 15

2.2 Vaccines and Vaccine Supply Systems ..................................................................... 15

2.3 Vaccine Situational Analysis in Kenya ..................................................................... 16

2.4 The current Kenya Vaccine Supply Chain Structure ................................................ 17

2.5 General Supply-Chain Management ......................................................................... 19

2.6 Review of existing models and systems in vaccine management ............................. 20

2.6.1 Online drug inventory & supply chain management system of Haryana .......... 20

2.7 Components of a Vaccine Stock Management Tool ................................................. 21

2.8 Cold Chain Systems .................................................................................................. 21

2.9 Functionality Testing for the Vaccine Stock Management Tool .............................. 22

2.10 Characteristics of Ideal Health Information Systems ................................................ 22

3 Chapter Three: Research Methodology and Design ......................................................... 24

3.1 Introduction ............................................................................................................... 24

3.2 Research Design ........................................................................................................ 24

3.3 Data Collection .......................................................................................................... 25

3.3.1 Observation ........................................................................................................ 25

3.3.2 Interview ............................................................................................................ 25

3.3.3 Secondary Data .................................................................................................. 25

3.4 Software Development Methodology ....................................................................... 25

3.5 Deliverables ............................................................................................................... 27

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3.5.1 System Modules ................................................................................................. 27

3.6 Conclusion ................................................................................................................. 27

4 Chapter Four: System Analysis and Design ..................................................................... 28

4.1 Introduction ............................................................................................................... 28

4.2 System Requirements ................................................................................................ 28

4.2.1 Functional Requirements ................................................................................... 28

4.2.2 Non-functional requirements ............................................................................. 28

4.3 System Analysis ........................................................................................................ 29

4.3.1 Entity Relation Diagram .................................................................................... 30

4.3.2 Use Case Modelling ........................................................................................... 31

4.3.3 Class Diagram .................................................................................................... 36

4.3.4 Database Schema ............................................................................................... 37

4.4 System Design ........................................................................................................... 38

4.4.1 High Level Architecture for the Vaccine Stock Management Tool .................. 38

5 Chapter Five: System Implementation and Testing ......................................................... 39

5.1 Introduction ............................................................................................................... 39

5.2 System Development Tools ...................................................................................... 39

5.3 Implementation methodology ................................................................................... 40

5.3.1 Tasks .................................................................................................................. 40

5.3.2 A web-based application .................................................................................... 42

5.3.3 End of Phase One and Piloting .......................................................................... 43

5.3.4 Features not Implemented .................................................................................. 43

5.4 Testing ....................................................................................................................... 43

5.4.1 Test Basis ........................................................................................................... 43

5.4.2 Test Approach .................................................................................................... 43

5.4.3 Testing Conclusion ............................................................................................ 44

5.5 System Deployment .................................................................................................. 44

6 Chapter Six: Conclusions and Recommendations ............................................................ 46

6.1 Conclusions ............................................................................................................... 46

6.2 Recommendations ..................................................................................................... 47

6.3 Future Work .............................................................................................................. 47

7 References ........................................................................................................................ 48

8 APPENDICES .................................................................................................................. 50

8.1 Appendix A: Cold Chain Room ................................................................................ 50

8.2 Appendix B: System Screen Shots ............................................................................ 51

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8.3 Appendix C: Sample System Code ........................................................................... 56

8.4 Appendix D: Central Vaccine Store Site Visit .......................................................... 57

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List of Figures Figure 2-1: The current vaccine supply chain structure ........................................................... 18

Figure 2-2: Procurement model for the system (Verma, 2014) ............................................... 20

Figure 3-1: Conceptual Research Design ................................................................................ 24

Figure 3-2: Agile system development methodology (Elezovic, E., 2012) ............................. 26

Figure 4-1: Entity relationship diagram ................................................................................... 30

Figure 4-2: Managing the Sub-County Module ....................................................................... 31

Figure 4-3: Managing the National Module ............................................................................ 32

Figure 4-4: Class Diagram ....................................................................................................... 36

Figure 4-5: Database Schema .................................................................................................. 37

Figure 4-6: Technology Stack .................................................................................................. 38

Figure 5-1: Manage stock Module ........................................................................................... 41

Figure 5-2: Cold Chain Module ............................................................................................... 42

Figure 8-1: Cold Chain room ................................................................................................... 50

Figure 8-2: Login Page ............................................................................................................ 51

Figure 8-3: Sample Admin Dashboard .................................................................................... 51

Figure 8-4: Manage Stock Module .......................................................................................... 52

Figure 8-5: Document Manager Module ................................................................................. 52

Figure 8-6: Cold Chain Management Module ......................................................................... 53

Figure 8-7: Reports Module ..................................................................................................... 53

Figure 8-8: Admin System Configuration Module .................................................................. 54

Figure 8-9: Failed Login .......................................................................................................... 54

Figure 8-10: Unauthorized Access Error ................................................................................. 55

Figure 8-11: Part of the research team during the Central Vaccine Store site visit ................. 57

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List of Tables Table 4-1: Use Cases List ........................................................................................................ 32

Table 4-2: Sub county Use Case .............................................................................................. 33

Table 4-3: Managing the National Module .............................................................................. 34

Table 5-1: Browser Compatibility tests ................................................................................... 44

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Abbreviations

CHAI – Clinton Health Access Initiative

DVI – Division of Vaccine and Immunization

EPI – Expanded Programme on Immunization

GAVI – Global Vaccine Alliance

GUI – Graphical User Interface

IPV – Inactivated polio vaccine

MDG – Millennium Development Goals

MoH – Ministry of Health

RFID – Radio Frequency Identification

ROTA – Rotavirus vaccine

UI – User Interface

WHO – World Health Organization

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1 Chapter One: Introduction

1.1 Background of the Study

According to the Kenyan constitution, every person has the right to the highest attainable

standard of health. It states that it is the right of every child to basic nutrition, shelter and

healthcare. The Government of Kenya, following its mandate stipulated in the Constitution to

provide healthcare to its citizens, has among one of its key ministries, the Ministry of Health.

The Ministry of Health, keen to ensure that children at a young age are saved and protected

from killer diseases such as Measles, Pneumonia, initiated a programme, The Division of

Vaccines and Immunization.

The Expanded Program on Immunization (EPI) established by the World Health Organization

(WHO) in 1974 to provide six vaccine-preventable diseases (tuberculosis, poliomyelitis,

diphtheria, tetanus, pertussis and measles) through routine infant immunization (T. Hyde et al,

2012). Since 2000, national-level Expanded Program on Immunization (EPI) have seen their

vaccine portfolio grow from 6 basic antigens to the 12 now recommended by the World Health

Organization (WHO) for all countries (Hyde et al., 2012). The new vaccine introductions have

put strains on vaccine supply chains around the world. Many low and middle income countries

have been forced to restructure their entire vaccine supply, logistic and reporting systems

components in order to get all the vaccines to their populations in a timely manner.

The diseases that children are immunised against are Measles, Tuberculosis, Pneumonia,

Diarrhoea, various respiratory infections and others. It is the duty of the Division of Vaccine

and Immunisation to ensure that all children in Kenya are fully vaccinated. It also checks and

ensures that vaccines are well maintained and monitors any responsive effects from the

immunizations. It dispenses vaccines to various health centres and also introducing new

vaccines.

In the last decade, we have seen a surge in interest and funding for new vaccine development

and introduction to many developing countries (Kaufmann, Miller & Cheyne, 2011). This

developments have become increasingly clear impacting the immunization and public health

in those countries, both in a positive and negative way. Third world countries are now

beginning add new vaccines and antigens to their standard immunization programs. M. Zaffran

et al. (2013) says the introduction of a new vaccine has the potential to reduce morbidity and

mortality associated with pneumonia, cancer and other diseases at the same time, access to all

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vaccines hinges on the ability of the already strained vaccine supply and logistic systems in

this countries.

In Kenya, the new vaccine landscape has been increasing with the Rotavirus vaccine introduced

in July 2014 and there are plans to introduce Inactivated Polio Vaccine, Human papilloma

Virus, Measles Rubella and switch to Bivalent oral polio vaccine (Chopra & Meindle, 2009).

The Rotavirus vaccine uptake was variable with slow uptake in some counties and rapid uptake

in other counties in terms of time and uptake. This was due to the existing inefficiencies in the

current supply system threatening the vaccine accessibility, quality and availability. With the

higher cost of these new vaccines, such programs are under considerable pressure to increase

performance through improved forecasting, wastage minimization and implementing efficient

vaccine management systems. Supply and logistic innovations are urgently needed to address

the current supply system bottlenecks.

The main challenge is difficulty in monitoring vaccines from the moment they leave the

national and regional stores. In the current system, this is almost impossible as keeping track

of how the vaccines are being used is a Herculean task. Kenya’s spending on vaccines is set to

grow from $14 million annually to $53 million due to the introduction of the diarrhoea vaccine

and a medically beneficial polio vaccine (Mvundura et al, 2015). This calls for an automated

and more sensitive system that provides increased visibility and analysis of vaccine stock data,

consumption data, and interventions that are possible with current resources at levels. Currently

this is done in excel based tools, already shared with national.

Another challenge faced is the concern about the security and potency of these vaccines. It is

difficult to uniquely identify vaccines. There is also lack of visibility on the working conditions

of cold chain equipment. This is at the sub-county and the health facility levels. There is need

to design a system that assures users of the originality and potency of vaccines through the use

of batch numbers. Also, decisions made by users in different levels of the system need to be

tracked.

It is against this background that the problem statement addressed in the current study was

formulated.

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1.2 Problem Statement

The Division of Vaccine and Immunization is facing increasing difficulty monitoring vaccines

and other commodities distribution once they have been distributed from the national stores.

The existing vaccine supply chain structure operates primarily as a “push system” where the

DVI calculates required vaccine quantities for each region and allocates stock to the region

stores. The system in place is only usable to users at the national level and the regional levels

and deals with the issuance and reception of vaccines and tracking of cold-chain equipment.

Some of the capabilities missing are the ability for users to track vaccine stocks, vaccine

utilisation and monitoring cold chain system.

With the introduction of new vaccines, more challenges have been anticipated with this

additions posing serious threat to the already over strained vaccine supply chain system in

Kenya. Access to all this vaccines will have surpassed the current ability of the existing supply

and logistic system to distribute, track and store the vaccines at proper temperatures, condition

and quality and ensure they reach their destinations in a timely manner.

Thus, it was essential that an improved and efficient vaccine stock management tool to be

developed to reduce wastage, stock outs, overstocking and expired stock. The developed

solution was available to users at all levels thus it facilitated vaccine stock tracking throughout

the vaccine supply chain. The developed solution was expected to collect information from the

various stores, transfer it to the national level, and notify the regional stores on stock availability

at the national level. The system would provide analytic information with the data gathered.

There are various problems that have been brought by using the current system. It was hard to

make any forecast on future stock needs, resulting in the Division of Vaccines and

Immunization being unable to make proper planning. Lack of keeping track of the vaccine

stock created a loophole for malicious people to take advantage and probably misuse these

vaccines. The system could not monitor Cold Chain equipment and temperature at the sub-

county and health facility levels.

1.3 General Objective

The general objectives of the project was to develop a vaccine management tool that helped

the Division of Vaccine and Immunization stakeholders from the national level down to the

regional, to the county level and the sub county level to efficiently and effectively manage

vaccine stocks, monitor the cold chain systems and run quality reports for decision making and

vaccine forecasting.

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1.4 Specific Objectives

The objectives of the project were:

a) To visit the central vaccines store to understand the vaccine stock management

techniques

b) To identify the current challenges faced in the vaccine supply chain in Kenya.

c) To design a system architecture that tracks vaccine utilization all the way from the sub-

county level to the national level.

d) To develop a system that manages and monitors the vaccine supply chain and cold chain

systems with the capacity to make forecasts on future needs.

e) To test the system.

1.5 Justification

With the current system, there are great challenges faced by its users, and with the government

set to introduce more vaccines, tracking vaccine stocks will be a Herculean task. However,

with the new developed system, this is made much easier. The major beneficiaries is the

government under the Ministry of Health. The government has time and time again had to go

through financial strain in order to buy vaccines which are left unaccounted for. With the new

system, the government is able to have an updated and accurate inventory.

Other beneficiaries of this system are the various users at the county and sub-county levels,

who make orders and have to wait; not knowing what time the stock will be brought to their

depots. This created lots of uncertainties, resulting in cases of inadequate stock in the depots,

in case the stocks fail to arrive in time. With the new system, they are able to get prompt

messages once their orders are approved, and in the case of rejection be provided with an

opportunity to reorder.

Also, administrators at different levels are able to keep count of their cold chain systems in a

much efficient way, and also keep track of the system’s users. Currently, this is quite difficult

with some of the users having provided details in the wrong format e.g. a user putting a random

word in place of his/ her phone number.

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1.6 Scope

The developed system is a web-based application going to be used by the Division of Vaccines

and Immunization Kenya. This system covers national, regional, county and sub-county levels

of the country. However, the system at the moment is not able to cover the health facilities at

the grass-root level. This means that the user at the sub-county level have to go to the health

facilities and get information of the vaccines needed and the quantity required. The user at the

sub-county level then place an order to the county depot on the vaccines needed.

The user at the county level then assess the order placed, and either approves or rejects. After

approval, the user at the sub-county level receives a prompt message to inform him of that.

However, if the order gets rejected, the user is prompted with a message giving the reasons the

order was rejected, and be able to reorder. Reports are generated to act as proof of any

transaction that goes through the system. Currently, these functionalities are not in existing

system.

With the information collected by the system on matters such as dates in which vaccines are

ordered and the quantity ordered, the system provides crucial information to be used for

analysis purposes. Therefore, forecasts are easily made so as to make early arrangements to

avoid any future crisis.

On managing cold chain systems, the system has an inventory detailing all the systems

uniquely. This provides an opportunity to easily track any missing systems, and easily detect

malfunctions. At the moment, the system only has records of the cold chain systems but has

not uniquely identified them.

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2 Chapter Two: Literature Review

2.1 Introduction

This chapter reviews published information, trends and guidelines in vaccine supply chain and

cold chain systems.

2.2 Vaccines and Vaccine Supply Systems

Over the years, mankind has dedicated himself in finding better solutions to various health

issues. According to a book written by the World Health Organization (W.H.O), immunization

is one of the most cost-effective of all health interventions and also crucial in the road to attain

the Millennium Development Goals (MDGs). Research carried out by the WHO also made an

estimate that if vaccination operations were to be widely and efficiently carried out, two million

more deaths among children under the age of five years can be averted (WHO Publications,

1985).

Immunization programs have severally added new vaccines to the original six vaccines. These

original vaccines are:

a) Measles

b) Polio

c) Tuberculosis

d) Diphtheria

e) Tetanus

f) Pertussis

New vaccines added include hepatitis B, mumps, pneumococcal disease, rotavirus, yellow

fever etc. (CHAI Documents, 2015).

Globally, governments use different ways to manage and disseminate vaccines to their people.

In the United States of America, the US Department of Health and Human Services implements

a well efficient system which deals with Vaccine Inventory Management, Storage Unit

Temperature Monitoring, Cold Chain Management as well as Staff Organization. . When it

comes to, Vaccine Inventory Accounting, the system is able to keep track of received vaccine

stocks, amount of current stock, amount already administered to children; amount wasted or

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expired and is also able to forecast which vaccines need to be reordered. An inspection and

update on vaccine stocks is done on a weekly basis.

In Cold Chain Management, vaccines are kept in a temperature-controlled environment so as

to be distributed in optimal conditions. The temperature of the storage units is also monitored

regularly to ensure that the appropriate conditions are maintained. This is because extreme

temperature conditions affect the vaccines thus reducing their potency.

In Africa, various countries, including Kenya have embraced similar systems to manage their

vaccines. According to a research carried out by the World Health Organization in Kenya,

Moldova, North Korea and other countries showed that approximately 50% of all vaccine doses

are wasted either before or after leaving the stores (Zaffran, 2013). This can be attributed to

supply chain management issues such as accidental freezing, expiry, breakage and even theft.

This poses a major challenge in economical circles since a lot of money is used to compensate

for these loses. In Kenya, the Division of Vaccines and Immunization has a system put in place

whose functions are to ensure vaccine stocks are well managed and monitored. (Ministry of

Public Health and Sanitation, 2013) This system however has a few challenges that need to be

rectified.

First, the system is only usable at the regional level. With the introduction of the new

constitution, a total of 47 counties were made. The system should be able to provide users as

far as the sub-county levels place their orders. This is done after the users at the sub-county

levels have received estimates on the number of vaccine stocks needed at the health facilities

in their respective counties. A situation analysis done by the Division of Vaccines and

Immunization identified that its programme was facing several setbacks.

One of these challenges is inadequacy or late disbursement of finances for procurement of

vaccines. This can be hugely attributed to the current system's inability to perform forecasts

and predict what vaccine stock will be required where and when. Another problem encountered

is vaccine stock outs at the depots. This can be attributed to late distribution from the national

depot. (Ministry of Public Health and Sanitation, 2013) Keenly monitoring the flow of vaccine

stocks right from the national depot, referred to as the central vaccine depot, will greatly boost

transparency and accountability.

2.3 Vaccine Situational Analysis in Kenya

The Division of Vaccine and Immunization has difficulty monitoring vaccine and other

commodity distribution once the vaccine have been distributed from the national stores. The

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division has a series of stores which vaccines are stored in refrigerators and have a distribution

network which utilizes cold boxes.

With the introduction of new beneficial vaccines (ROTA and IPV), the country is bound to

experience significant strain on an already overloaded vaccine supply and logistics systems. It

follows that we can easily resolve part of the challenge by; implementing supply systems that

support efficient and effective vaccine delivery and that enable better and timely decision-

making. This means there is more need than ever to have a robust system than while ensuring

effectiveness provides increased accountability and traceability.

The current stock outs about 56% in all facilities affect over 200,000 children monthly, with

immunization drop out as large as 25%, we are risking loss of lives for over 50,000 children

(CHAI Documents, 2015). We can save lives all these children by streamlining vaccine

delivery, through technology as part of other interventions.

There has been increased concerns about security and potency of vaccines, in Kenya. There

currently exists little information on the working status of the cold chain at sub-county stores

and health facilities, and their capacity to store vaccines. There is need to build a system that

ensure verifiability of vaccines against batch numbers, to allow retrieving vaccines, so as not

to harm our children.

With the decentralization health there is need for relegation of decision making from National

to County Level, this decision making needs to be evidence based. A vaccine information

system will provide the necessary information for these actions.

Availability of quality, real time data on vaccine supply and demand at the national, regional,

and lower levels would be critical to supporting improved efficiencies in how vaccines are

managed.

2.4 The current Kenya Vaccine Supply Chain Structure

The Kenya Expanded Program on Immunization, is called the Division of Vaccines and

Immunization (DVI) under the Ministry of Health in Kenya. DVI, with support from Clinton

Health Access Initiative (CHAI), developed a Supply Management Tool (SMT) currently being

used by the central vaccine store and 6 of the 7 regional vaccine stores in Kenya. The SMT

allows users to input a variety of information, including dates of arrival of antigen shipments

at central and regional vaccine stores, quantities procured, expiry dates and weekly stock status.

The existing vaccine supply chain structure operates primarily as a “push system” where the

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DVI calculates required vaccine quantities for each region and distributes to the region stores

(Figure 1). The counties and sub counties levels the submit stock order to their respective

regional stores

Figure 2-1: The current vaccine supply chain structure

The current bottlenecks posed by the supply chain structure were:

a) Frequent vaccine stock outs affecting the whole country

b) Mix-ups of vaccines with diluents from different manufacturers

c) Stock records are not up to date especially at central and sub-national levels and regular

physical counts are not conducted and recorded in stock ledgers

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d) Use of the push system as opposed to the recommended pull system is causing over or

under stocking of vaccines in some facilities as it is not based on individual

performance

e) Unreliable minimum and maximum stock levels as they were not related to facility

coverage data

f) Vaccine wastage not included and factored in vaccine forecasts

2.5 General Supply-Chain Management

A supply chain management system includes all personnel, systems, equipment, and activities

involved in ensuring that the commodities involved are effectively delivered from the point of

production to the person who needs the commodity (Chopra & Meindle, 2009).

The most effective supply chain system should include financial planning, forecasting,

distribution and procurement processes to create a seamless end-to-end system. Modern

inventory systems and supply chains can provide precision and transparency.

General concepts of supply-chain management are changing, increasingly emphasis is placed

more on moving products and less on storing them. Excessive inventory is now seen by supply-

chain experts to be inefficient because it ties up resources that could be better used elsewhere.

When supply-chain managers have access to reliable information about customers’ needs,

production information and delivery schedules, there is less need for large inventories.

There are two different well known types of stock management systems. These are:

a) “Push” or Allocation systems

b) “Pull” or Requisition systems

In the push or allocation systems, distribution decisions are made by higher-level facilities. The

quantities distributed are usually based on usage and stock reports without receiving

requisitions.

In the pull systems, the lower level facilities are responsible for ordering supplies. Decisions

on quantities distributed are made by lower level managers in charge of supply.

Minimum/maximum (min/max) inventory control system is recommended in stock

management systems. Using a min/max inventory control system help managers to prevent

both over-stocking and stock outs.

Minimum stock level is the level below which stocks should never drop without having placed

an order.

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Maximum stock level is set to guard against oversupply, it consists of the minimum stock plus

that amount of stock which is normally used between orders

2.6 Review of existing models and systems in vaccine management

2.6.1 Online drug inventory & supply chain management system of Haryana

In 2014, the Government of Haryana launched an online drug inventory and supply chain

management system (SCMIS), the system had been developed to integrate various inter-related

activities of the National Rural Health Mission (NRHM) Haryana (Verma., 2014). The

application has been operational since March 2013 and in accordance to the New Drug Policy

of Government of Haryana. Prior to the initiative, there were literally no tools to monitor and

evaluate demand, consumption, inspection budget and other documentary evidences.

The new system was designed and developed with the following objectives in mind:

a) To improve efficiency and effectiveness of procurement and distribution systems

through robust quality controls

b) To provide dashboard based online monitoring of all activities at each level

c) Tracking of vendor activities like preparation of Supply Order and Shipment

d) Monitoring of Drug consumption pattern

Figure 2-2: Procurement model for the system (Verma, 2014)

The system prevalent challenges at that time was fraught with errors and there was no control

on critical issues like alerts on expiry medicine, supply of medicine by vendors, whether drugs

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have reached the reordering level etc. The system led to lots of time wastage and requires

continuous monitoring to ensure that each transaction is accounted for and makes inventory

record keeping a more cumbersome process for the operator. Not more than one person was

able to access data at the same time unless they keep multiple copies of reports and the resultant

paper work takes lot of space and often searching the relevant information becomes a tedious

exercise.

2.7 Components of a Vaccine Stock Management Tool

Computerized stock controls systems run on similar principles to paper based ones, but are

more flexible and information is easier to retrieve. You can quickly get a stock valuation or

find out how well a particular item of stock is moving.

A computerized system is a good option for businesses dealing with many different types of

stock. Other useful features include:

Stock and pricing data integrating with accounting and invoicing systems. All the systems draw

on the same set of data, so you only have to input the data once. Sales Order Processing and

Purchase Order Processing can be integrated in the system so that stock balances and statistics

are automatically updated as orders are processed.

a) Automatic stock monitoring, triggering orders when the re-order level is reached.

b) Automatic batch control if you produce goods in batches.

c) Identifying the cheapest and fastest suppliers.

d) Bar coding systems which speed up processing and recording. The software will print

and read bar codes from your computer.

e) Radio Frequency Identification (RFID) which enables individual products or

components to be tracked throughout the supply chain. See the page in this guide on

using RFID for inventory control, stock security and quality management (Info

Entrepreneurs, 2010).

2.8 Cold Chain Systems

Cold chain management includes all of the means used to ensure a constant temperature

(between +2°C and +8°C) for a product that is not heat stable (such as vaccines, serums, tests,

etc.), from the time it is manufactured until the time it is used.

It involves the equipment and people needed to keep vaccines at the correct temperature

(between +2°C to +8°C) during transport and storage from the time they are manufactured up

until they are administered.

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The cold chain must never be broken. Vaccines are sensitive to heat and extreme cold and must

be kept at the correct temperature at all times.

Health workers at all levels are often responsible for maintaining the cold chain while vaccines

are stored in the vaccine stores at the province and county levels, or while they are being

transported to township and villages, and while they are being used during immunization

sessions or rounds. More and more often it is becoming the logistician’s responsibility to

manage the cold chain as a part of the supply chain (Logcluster, 2004).

The need to monitor cold chain systems arises because they suffer weaknesses which include:

a) Loss of vaccines from accidental freezing

b) Inaccuracy in that for most cold chain applications, a sensor accuracy of ±0.5 °C or

better is expected.

2.9 Functionality Testing for the Vaccine Stock Management Tool

Functionality testing is performed to verify that a system software application performs and

functions properly according to design specifications. The role of functional testing is to

validate the behaviour of an application. The functional tests define your system in a useful

manner. Functional testing is not always concentrating on customer requirements and whereas

Non-functional testing is always concentrating on customer expectations.

There are two types of Functional testing, Positive and negative functional testing. In positive

functional testing applications functions are tested with valid input and also verifying that the

outputs are correct. In negative functional testing the testing involves exercising application

functionality suing a combination of invalid inputs.

2.10 Characteristics of Ideal Health Information Systems

With the recent automation of many systems in the country, there is need to prioritize the

adoption of health information systems with ideal characteristics to ensure improved decision-

making, faster processing speeds and facilitate information sharing.

An information system can be said to be ideal if it meets this characteristics (Zaffran etal,

2013):

• Integrated and interoperable with other health information systems.

• Built on reliable data collected at the place where the events occur and aggregated or

disaggregated as needed.

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• Flexible, adaptable, and compatible with different contexts, programs, and changes over time

as needs evolve.

• Driven by the needs of end-users, managers, planners, recipients of health services, and other

stakeholders.

• Affordable and sustainable so decision-makers can evaluate the wider cost implications of

adopting an information system across the health system.

• Reliable and secure from unauthorized use.

• Built upon a consistent design framework with standards, common data, common software

applications, and technologies that are properly supported by clear design and user

documentation.

• Designed and used for evidence-based decision-making.

24

3 Chapter Three: Research Methodology and Design

3.1 Introduction

The main objective of this research was to develop a vaccine management tool for the Division

of Vaccine and Immunization Kenya. This chapter outlines the methodology, data collection

and analysis techniques that were used in carrying out the research to get information prior to

the design and development of the system. A research method is the arrangement of conditions

for collection and analysis of data in a manner that aims to combine relevance to the research

purpose with economy in procedures (Selltiz., Wrightsman & Cook, 1976).

3.2 Research Design

The design describes the purpose of the study and kinds of questions being addressed, the

techniques to be used for collecting data, approaches to selecting samples and how the data are

going to be analysed (Gray, 2009).

Due to the nature of this study, a qualitative approach was therefore used. [Figure number]

presents a conceptual research design of this study.

Figure 3-1: Conceptual Research Design

25

3.3 Data Collection

Both Primary and Secondary Data were collected and analysed during the study. The primary

data were gathered through face to face and guided interviews and participatory observation at

the national central vaccine store in Kitengela and the secondary data gathered from different

books, journals and related publications.

3.3.1 Observation

Observation involves the systematic viewing of people's actions and the recording, analysis

and interpretation of their behaviour. We visited the national central vaccine store in Kitengela

where we involved ourselves in having formal and informal discussions with the users and

system administrators to obtain useful inputs while developing the system. This was considered

to be the best way of obtaining information that could not be captured in the interviews.

3.3.2 Interview

An interview is a structure conversation between people in which one person has the role of

researcher and aims to discover the truth or the unknowns. Interviews are preferable to

questionnaire where questions are either open-ended or complex, or where the logical order of

questions is difficulty to predetermine and it is the favoured approach where better reliability

of data is desired (Gray, 2009).

We researcher used this tool purposely to get information that could not be obtained through

participatory observations. Through interviews, it was possible to ask interviewees (system

users and program administrators) supplementary questions on the research problem.

3.3.3 Secondary Data

Secondary data were collected through various published books, some reports with similar

interest (Vaccines inventory and logistic systems).

The system development thus borrowed much from the existing literature on similar interests.

3.4 Software Development Methodology

Methodology is a set of standards to initiate and manage individual projects. It provides tools to

make the project manager’s job a little easier. A system development methodology is referred

to as a standard process used to conduct all the steps necessary to analyse, design, implement

and maintain information systems (Benzzine, 2002).

26

The system development methodology aims to produce a high quality software that meets

customer expectations, reaches completion within times and cost estimates. It contains

definitions, guidelines, and templates for the various project management activities needed to

deliver successful projects.

The vaccine stock management tool was developed following the agile methodology approach

to achieve its intended objectives. This helped the development team keep focus on process

adaptability and customer satisfaction by rapid delivery of working software product in

iterative builds.

The agile methodology was used because:

a) Functionality could be developed rapidly and demonstrated.

b) Suitable for fixed or changing system requirements

c) Enabled concurrent development and delivery within an overall planned context.

d) Promoted teamwork and cross training.

e) Resource requirements were minimum.

f) Delivered early partial working solutions.

Figure 3-2: Agile system development methodology (Elezovic, E., 2012)

27

Client interaction is the backbone of Agile methodology, and open communication with

minimum documentation are the typical features of Agile development environment. This

worked well for us as we were having regular meetings with the project co-ordinators from the

Clinton Health Access Initiative offices.

3.5 Deliverables

The following are the expected deliverables of the system:

a) Fully functioning stock management system

b) System documentation

c) System user manual

3.5.1 System Modules

The tool was design in a modular approach with different users been assigned different roles

and permission to different modules. The vaccine stock management tools modules to be

delivered in this project include but not limited to:

a) Manage stock

b) Cold Chain

c) Reports

d) Documents

e) Configurations

3.6 Conclusion

In this chapter, the research methods selected for the research were discussed. This research

primarily uses document analysis, interview and observation for facts finding purposes. The

systems development methodology selected is agile methodology as it offers numerous

benefits which are well suited for rapid development web-based applications. There was also

a review of the deliverables that were aimed at in the conducting of this research.

28

4 Chapter Four: System Analysis and Design

4.1 Introduction

In order to carry out an extensive system design, use case diagrams, data flow diagrams and

system sequence diagrams were used. We also did an analysis of the system development

requirements is carried out in this chapter. The main challenge was to develop a system that

will enable the access to all vaccines and the new ones in development without posing great

challenges on the system’s ability to distribute, track and keep accurate inventory of the

vaccines at proper temperatures, conditions and quality in a timely manner.

4.2 System Requirements

System requirement are all the capabilities that the news system must have. The purpose is to

provide information for the next steps in the analysis phase to define the scope of the system.

An analysis strategy consists of require analysis techniques and information gathering

techniques. We take a look at the requirements for the system, the descriptions of what the

system does and the constraints on its operation (Somerville, 2011). It gives an insight as to the

basic requirements to facilitate efficient use of the system by a user.

4.2.1 Functional Requirements

Functional requirements refer to what the system should do. Below are the functional

requirements of the vaccine stock management tool:

a) System generates reports that show details of any transaction that occurs in the system.

b) EPI Logisticians can make vaccine orders via the system at all levels.

c) National MET users can manage cold chain spare parts inventory at national levels.

d) The system should be able to register new users at all levels and assign them specific

roles and permissions.

e) The system should allow system user to generate reports as when required.

4.2.2 Non-functional requirements

Non-functional system requirements describe how the system should work. Below are the non-

functional requirements:

a) The system increased reliability because reports will be generated to keep track of the

vaccine stocks. Vaccine quality can only be assured if the product is correctly stored

and handled from the point of manufacture to the point of use. The system can only

establish with certainty that quality has been maintained when detailed records are kept

and these records are reliable.

29

b) Users with basic computer skills should be able to use the new system and the system

should be robust.

c) The system should be mobile responsive and run well on any screen size. The rollout

plan targets to issue out tablets to all system users.

d) Non authorised users should be denied access to the system. All system data should be

secured at all times (See Appendix B).

4.3 System Analysis

The requirements for a system refer to the descriptions of what the system should do—the

services that it provides and the constraints on its operation. These requirements reflect the

needs of customers for a system that serves a certain purpose. Software Requirements Analysis

is the process of finding out, analysing, documenting and checking these services and

constraints. There are two system requirements appreciated during the development i.e.

functional system requirements and non-functional system requirements (Extensively covered

in the previous section). System analysis is a problem solving technique that decomposes a

system into its component pieces for the purpose of studying how well those component parts

work and interact with each other to accomplish their purpose (Hyde et al, 2012).

So as to fully understand the various functions the program should perform the following tools

were used:

a) Feasibility Studies – determining whether the product or project is worth the time

and effort. It describes features and benefits of the product, itemizes costs, resources

and staffing then describes the projects potential profits or value to the organization.

b) Flowcharts – this is the diagrammatic representation of a process. It describes a

series of steps or decisions in visual form in a manner that facilitates

communication.

c) Requirements Lists - should be organized by categories. As the list grows, this list

helps the analyst understand the customer's needs and helps limit what features are

necessary and which are not.

30

4.3.1 Entity Relation Diagram

An Entity Relationship Model is a detailed logical representation of data in an organization. It

is expressed in terms of the relationships among entities and the attributes of entities and their

relationships. Figure 4 show the entity relationships in our system.

Figure 4-1: Entity relationship diagram

31

4.3.2 Use Case Modelling

Uses cases are text based methods of describing and documenting complex processes. Use case

is a set of activities that produce some output result. They describe how the system reacts to an

event that triggers the system. Figure 5.1 and Table 5.1 show the Use Case Diagram of Vaccine

Stock Management Tool.

Figure 4-2: Managing the Sub-County Module

32

Figure 4-3: Managing the National Module

4.3.2.1 Use Case List

Table 4-1: Use Cases List

Use Case ID Primary Actor

UC 1 Sub County EPI Logistician

UC 2 National EPI Logistician

33

4.3.2.2 Sub County EPI Logistician Use Case

Table 4-2: Sub county Use Case

Use Case ID: UC 1

Use Case

Name:

Managing the Sub-County Module

Created By: Julie Otieno Egesa Last Updated By: Julie Otieno Egesa

Date Created: 28th October 2015 Last Revision Date: 29th December 2015

Actors: 1. Sub County Manager

2. Regional Manager

3. Health Facility

4. DHIS (Kenya Health Information System)

Description: This Use Case describes the process by which vaccines stocks are supplied and

distributed at the Sub County level. It also sets up a stock ledger platform for

inventory management at the Sub County level

Trigger: Sub County Manager login to the system

Preconditions: 1. Sub County Depot has a working stock balance

2. Stock levels at the Sub County are near or below minimum stock requirement.

Postconditions: 1. Sub County meets the vaccines demand from the Heath facilities

2. Sub County managers maintain accurate vaccine stocks records for planning

and forecasting.

Normal Flow: 1. Sub County manager login system

2. Sub County manager places an order to the Regional depot manager

3. Regional managers issues vaccines against the order

4. Sub County manager receives stock from Region depot

5. Sub County manager checks on the consignment condition

6. Sub County manager adds stock and update batch information in their

inventories

7. Sub County manager receives vaccines order from the Health Facility

8. Sub County manager issues vaccines to the Health Facilities

9. Sub County manager manages the Health Facilities in its area

34

10. Sub County manager pulls vaccine immunization reports and information

from the DHIS

Alternative

Flows:

[Alternative

Flow 1 –

County has

own depot]

2a. In step 2 of the normal flow, if the Sub County is in a County that has a depot

1. System will prompt Sub County manager to place the order to the County

depot manager

2. Sub County manager accepts

3. Use Case resumes on step 5

4b. In step 2 of the normal flow, if the Sub County is in a County that has a depot

1. System will prompt Sub County manager to place the order to the County

depot manager

2. Sub County manager declines

3. Order is placed to the Region Depot manager

4. Use Case resumes on step 3 of normal flow

Exceptions: 2a. In step 5 of the normal flow, if the consignment are discover to have quality

and/or quantity discrepancies

1. Sub County manager reports the issue

2. Order is rejected and returned to the Regional Depot

3. Regional Depot updates his/her stock information

4. Use Case resumes on step 7 of normal flow]

4.3.2.3 National EPI Logistician Use Case

Table 4-3: Managing the National Module

Use Case ID: UC 2

Use Case

Name:

Managing the National Module

Created By: Julie Otieno Egesa Last Updated By: Julie Otieno Egesa

Date Created: 28th October 2015 Last Revision Date: 25th February 2016

Actors: 1. National Manager

35

2. Regional Manager

Description: This Use Case describes the process by which vaccines are purchased from world

vaccines distributors and donors to serve the country demands. It also sets up a

stock ledger platform for inventory management at the National level

Trigger: National Depot Manager login to the system

Preconditions: 1. National Depot has a working stock balance

Postconditions: 1. National Manager purchases vaccines and cold chain equipment.

2. Sub County managers maintain accurate vaccine stocks records for planning

and forecasting.

Normal Flow: 1. National Manager login system

2. Purchase Vaccines

3. National Manager adds stock and update batch information in their

inventories

4. National Manager receives vaccines order from the Regions

5. National Manager issues vaccines against the order from Regions

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4.3.3 Class Diagram

The system was developed following an object-oriented analysis and design approach. The

class diagram show some of the classes of the system, their interrelationships (including

inheritance, aggregation, and association), and the operations and attributes of the classes.

Figure 4-4: Class Diagram

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4.3.4 Database Schema

A database schema is the skeleton structure that represents the logical view of the entire

database. It defines how the data is organized and how the relations among them are associated.

Figure 4-5: Database Schema

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4.4 System Design

4.4.1 High Level Architecture for the Vaccine Stock Management Tool

This architectural design is an overview of the technological architecture stack on which the

Vaccine Stock Management Tool was built on. It shows a high level view of the main

components of the tool, services and how they interact and communicate with each other.

The system is based on a client – server architecture, with both the client and server providing

their respective interfaces for interaction/communication. The system is web-based and can be

accessed through a website address (see Appendix) from any device connected to the internet

(Client). The system will include a robust relational database on a secure webserver that

running Apache 2.5 (Server).

Figure 4-6: Technology Stack

39

5 Chapter Five: System Implementation and Testing

5.1 Introduction

This chapter discusses the technology tools used in developing the system, explains how the

system implementation and its core functions. It also takes a look at the system testing

techniques that were carried out on the system.

5.2 System Development Tools

The programming language used was PHP v5.6, a web server scripting language for the

backend. We used code igniter, an application development framework that is used to build

websites using PHP. In the frontend, we used twitter bootstrap a frontend web framework for

building mobile friendly websites using HTML5, CSS3 and JavaScript. We store all the

application data and data object on MySQL, a relational database management system.

Other tools used during system development include:

a) AJAX (Asynchronous JavaScript and XML): AJAX is a technique for creating

fast and dynamic web pages. AJAX allows web pages to be updated

asynchronously by exchanging small amounts of data with the server behind the

scenes, making it possible to update parts of a webpage, without having to

reload the whole page. AJAX applications are browser and platform

independent.

b) JavaScript: JavaScript is a scripting language developed by Netscape to help in

designing interactive sites. It blends well with other web technologies such as

HTML and CSS. JavaScript allows us to build highly responsive user interfaces

and mostly came in handy during form validations.

c) Code Igniter: It is an application development framework for people who are

building web applications using PHP and are looking for a lightweight

framework with a small footprint.

d) Ms Office Visio 2013: An Office suite software used to create professional-

looking diagrams for designing, understanding, documenting and analysing

information, data, systems and process.

e) Sublime Text: A cross platform text editor used for code, markup and prose for

coding. This was the actual tool on which the system code was edited and

debugged during the system development.

40

5.3 Implementation methodology

5.3.1 Tasks

Based on the magnitude and timelines applicable to the undertaking of the project, we were

inclined towards an agile methodology approach. This was beneficial to both the clients’

coordinators (Clinton Health Access Initiative Team) and the final system users. We had the

initial meeting were the tasks and requirements were handed over to the team tasked with the

development of the task. The successive meeting were all about refining the problem statement

and reviewing the system requirements. A technology stack was chosen based on the

requirements we had already been brief on. The technology stack decisions were informed

based on security, scalability and robustness of the system during the roll out.

With an always growing list of user requirements as is case with most large projects, agile

methodology helped us maintain a list of product backlogs. The list was managed on a feature

priority basis that saw the first prototype shipped with the most basic and essential features.

There was always a review and testing done upon each release. We could build on the feedback

and keep updating the product backlogs. Then we could work on the next build, this

incremental approach saw the product get better and better with each release and a reducing

item list on the project backlog list

A basic stock management system was first implemented and after being tested and debugged

the other features and functionalities were added to the system. Every feature was individually

tested and in conjunction with the rest of the system. We followed a more pragmatic

programming techniques where all system component were highly modularised and tightly

coupled, thus they could be removed from the system and test ran on them extensively.

The components were built on each other as subsystems until a vaccine stock management tool

was produced, which matched the specification. The subsystem were divided as per modules.

The main modules in this project included:

a) Stock management module

b) Cold chain management module

c) User management and authentication module

d) Document management module

e) Database and data objects management module

41

5.3.1.1 Manage Stock

This is the module involved in the stock management and supply of the vaccines in the system.

The main users who mostly interact with this modules are the EPI Logisticians who are in

charge of ordering, issuing and managing vaccine stock at the various vaccine stores and the

public health nurse who are responsive if the vaccine stock at facility levels. Other system users

can only view vaccine ledgers at their respective stations.

Figure 5-1: Manage stock Module

5.3.1.2 Cold Chain

This module provides interfaces for managing the cold chain part of the vaccine supply chain.

It consist of the cold chain equipment spare part inventory, temperature monitoring, job card

management for fixing the cold chain equipment and managing field engineers. The main users

interacting with this module are the medical equipment technicians (MET users).

42

Figure 5-2: Cold Chain Module

5.3.1.3 Reports

This interface displays the various reports that can be generated from the system based on the

users’ designations. (See Appendix B)

5.3.1.4 Documents

This interface displays the various documents, newsletters and communications that can be

downloaded from the system based on the users’ designations. (See Appendix B)

5.3.1.5 Configurations

This can only be accessed by the administrators at the national level currently. This modules is

responsible in major system customization settings and user management functions. (See

Appendix B)

5.3.2 A web-based application

A fully operation web-based vaccine stock management system was produced. The web-based

vaccine stock management system was produced with PHP code igniter framework backend.

The implementation of the GUI subsystem was done using twitter bootstrap framework.

43

Certain basic features re-used as there were many available open source PHP vaccine inventory

management systems.

5.3.3 End of Phase One and Piloting

The completion of phase one was announced on 18th February 2016, with plans to roll out the

first phase of the system in the national central vaccines store and regional vaccine stores set

out for discussions with the people in the Ministry of Health. This stage is to serve as a further

testing and review on a wider scale function. We plan to continue building up the system till

the problem statement is well addressed.

5.3.4 Features not Implemented

A number of features of the vaccine stock management tool were not implemented as on the

submission of this document because of time constraints. Most of the reporting module is yet

to be built as we are still in discussions on the types of report to be generated by the system

with a keen concern of the system latency and utilization.

The remote temperature monitoring was also not implemented because of lack of time and

limited documentation on using a machine sensors data logs with the procured thermometers.

I will however be implementing this in the next build that will be released with the current

feedback and product backlogs.

5.4 Testing

The vaccine stock management tool was tested throughout its development lifecycle by fellow

developers attached to the Strathmore HP lab, project supervisor from Strathmore University,

program coordinators from the Clinton Health Access Initiative – Kenya and selected

individuals from the Ministry of Health.

5.4.1 Test Basis

The testing of the vaccine stock management tool was done as it was been implemented, that

was the basis of incremental development. Every component of the tool was individually tested

for statement coverage and its functionality verified. Features and components were only

integrated to the system after they passed the test criteria.

When a feature failed the test criteria, the implementation was debugged and in some occasions

the design revised, until the cause of the error is found and resolved.

5.4.2 Test Approach

There were three approaches used to test the system:

44

a) Functional testing

b) Usability testing

c) Compatibility testing

5.4.2.1 Functional Testing

Functional testing was done to determine if the various functionalities of the system were

working as they were expected to work. All the modules were individually tested before and

after integration. Before integration, each module was tested with sample data.

5.4.2.2 Usability Testing

Usability testing was done to determine the ease of use of the system and whether the users

would struggle to learn and use the system. This was done prior to the announcement of the

end of phase one of the project with the eventual system users, selected individuals from the

Ministry of Health.

5.4.2.3 Compatibility Testing

Compatibility testing was done to determine whether the system developed would work on

different web browsers. The vaccine stock management tool is compatible with all the major

modern web browsers in the market. The system works when java script is enabled in the

browser.

Table 5-1: Browser Compatibility tests

Chrome Firefox Opera Edge Safari

System renders well YES YES YES YES YES

The system is also compatible with the personal computers, laptops and mobile platforms. It

runs all the major operation system distributions i.e. Windows, Mac and Linux.

5.4.3 Testing Conclusion

The test results from all the types of testing conducted, we confirmed that the tool met the

qualities of a robust, highly available and user friendly.

5.5 System Deployment

The vaccine stock management tool would be hosted on a web server with a public IP address

in order to be accessible to all the system users at their different stations. There should be a

MySQL server install in the same server or hosted on a server that the web server has access

45

to. For robustness and quick recovery there would different environment set up i.e. (Production

and Development) and a MySQL replication should be setup for the database.

46

6 Chapter Six: Conclusions and Recommendations

6.1 Conclusions

This research study was conducted in order to provide a solution to address the vaccine supply

and stock management inefficiencies within the Division of Vaccine and Immunization

department in the Ministry of Health. The aim was to propose and develop a new vaccine stock

management tool that would replace the existing system. The current system faced/is facing

major bottleneck which include; frequent vaccine stock outs affecting the whole country, mix-

up of vaccines with diluents from different manufacturers, inaccurate stock inventories and

unreliable minimum and maximum stock levels.

The challenges were set to get even bigger with the addition of basic vaccine and antigen

recommendations by WHO from 6 to 12 for all countries. This would pose a serious threat to

an already over strained vaccine supply system in the country. Access to all this vaccines will

have surpassed the current ability of the existing supply and logistic system to distribute, track

and store the vaccines at proper temperatures, condition and quality and ensure they reach their

destinations in a timely manner. It follows that we can easily resolve part of the challenge by;

implementing supply systems that support efficient and effective vaccine delivery and that

enable better and timely decision-making

There have been many discussions and reports about this subject matter, and a number of

recommendations have been put across to the team at the Division of Vaccine and

Immunization (DVI) from the donors and GAVI alliance on solving this problem. Among them

is the adoption of a “pull” vaccine supply chain system rather than the “push” vaccine supply

chain system that is currently been used. Such a switch will not only help minimize the frequent

stock outs, but also increase transparency and accountability within the entire system.

This research therefore proposed an implementation of the “pull” vaccine supply chain system

in Kenya. The developed solution was therefore developed with such requirements in mind and

seek integrate well with the existing health systems in the sector. The developed solution is a

web based system that collates information from the various stores to the national level and

also informs the regional stores on stock availability at the national level. The system does

analysis using the stock ledger to act as an early warning system and other derivatives.

47

The adoption of the developed solution would see the following benefits; increased visibility,

accountability and traceability of stocks at all levels, packaged immunization data in ways that

ease/prompt decision making, planning /and taking real time actions and developed and

sustained use of Cold Chain Equipment and Temperature Monitoring information for planning

and actions

6.2 Recommendations

The following recommendations are offered for related research in the field of technology and

vaccines.

a) All targeted users with no computer skills should be given basic training on computer

system to ensure that they are able to work with technologies introduce to them in future

and have positive attitude towards technology.

b) There should be a series of conferences and workshops organised throughout the

country to ensure all stakeholders are aware of the current implementation and

transitions taking shape in this sector.

c) Ensure availability of internet accessibility at the facilities where the tool will used, this

will ensure the availability of the tool 24/7.

6.3 Future Work

Further research can be conducted to find out what other techniques can be used to enable

seamless interoperability of the tool with other health systems. Further improvements can also

be made on the algorithms used in the system to increase the speed and efficiency of the tool.

Use of a thin server application tier to increase scalability of the tool through use of APIs can

also be considered.

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7 References

Benzzine, A. (2002). System Development Methodologies a framework for comparison.

Retrieved from University of Missouri:

http://www.umsl.edu/~sauterv/analysis/488_f02_papers/methodologies.html

CHAI Documents. (2015). National Vaccine Supply Documents, 14(2).

Chopra, S., & Meindl, P. (2007). Supply chain management: Strategy, planning, and

operation. Upper Saddle River, NJ: Pearson Prentice Hall.

Elezovic, E. (2012, December). Agile Methodology. Retrieved March 03, 2016, from

http://www.adfkickstart.com/agile-methodology

Hyde, T. B., Dentz, H., Wang, S. A., Burchett, H. E., Mounier-Jack, S., & Mantel, C. F.

(2012). The impact of new vaccine introduction on immunization and health systems: A

review of the published literature. Vaccine, 30(45), 6347-6358.

Kaufmann, J, Miller, R, & Cheyne, J. (2011). Vaccine Supply Chains Need To Be Better

Funded And Strengthened, Or Lives Will Be At Risk

Logistics update / March 16th - 22nd 2006 | Logistics Cluster. (16 March 2006.). Retrieved

March 18, 2016, from http://www.logcluster.org/document/bulletin-39-logistics-update-

march-16th-22nd-2006

Mvunduraa, M, Lorensona, K, Chweyab, A, Kigadyec, R, Bartholomewa, K, Makamef, M,

& Otieno, A. (2015). Estimating the costs of the vaccine supply chain and service delivery

for selected districts in Kenya and Tanzania. Vaccine, 33

Shikanga, O., Mutonga, D., Abade, M., Amwayi, S., Ope, M., Limo, H., . . . Feikin, D. R.

(2009). High Mortality in a Cholera Outbreak in Western Kenya after Post-Election

Violence in 2008. American Journal of Tropical Medicine and Hygiene, 81(6).

WHO Recommendations for Routine Immunization: A User’s Guide ... (n.d.). Retrieved

February 24, 2016, from

http://www.who.int/immunization/policy/WHO_EPI_Sum_tables_Def_200713.pdf

WHO Publications. (1985). Int J Epidemiol International Journal of Epidemiology, 14(2),

354-354.

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Verma, v. (2014). Online drug inventory & supply chain management system of haryana.

Online drug inventory & supply chain management system of haryana. Retrieved March

18, 2016.

Zaffran, M., Vandelaer, J., Kristensen, D., Melgaard, B., Yadav, P., Antwi-Agyei, K., &

Lasher, H. (2013). The imperative for stronger vaccine supply and logistics systems.

Vaccine, 31.

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8 APPENDICES

8.1 Appendix A: Cold Chain Room

Figure 8-1: Cold Chain room

51

8.2 Appendix B: System Screen Shots

Figure 8-2: Login Page

Figure 8-3: Sample Admin Dashboard

52

Figure 8-4: Manage Stock Module

Figure 8-5: Document Manager Module

53

Figure 8-6: Cold Chain Management Module

Figure 8-7: Reports Module

54

Figure 8-8: Admin System Configuration Module

Figure 8-9: Failed Login

55

Figure 8-10: Unauthorized Access Error

56

8.3 Appendix C: Sample System Code

<?php

class Spareparts extends MY_Controller {

function __construct() {

parent::__construct();

// $this->output->enable_profiler(true);

Modules::run('secure_tings/ni_met');

}

public function index()

{

// Modules::run('secure_tings/ni_met');

$this->load->model('mdl_spareparts');

$this->load->library('pagination');

$this->load->library('table');

$config['base_url'] = base_url().'/spareparts/index';

$config['total_rows'] = $this->mdl_spareparts->get('id')->num_rows;

$config['per_page'] = 10;

$config['num_links'] = 4;

$config['full_tag_open'] = '<div><ul class="pagination pagination-

small pagination-centered">';

$config['full_tag_close'] = '</ul></div>';

$config['num_tag_open'] = '<li>';

$config['num_tag_close'] = '</li>';

$config['cur_tag_open'] = "<li class='disabled'><li

class='active'><a href='#'>";

$config['cur_tag_close'] = "<span class='sr-

only'></span></a></li>";

$config['next_tag_open'] = "<li>";

$config['next_tagl_close'] = "</li>";

$config['prev_tag_open'] = "<li>";

$config['prev_tagl_close'] = "</li>";

$config['first_tag_open'] = "<li>";

$config['first_tagl_close'] = "</li>";

$config['last_tag_open'] = "<li>";

$config['last_tagl_close'] = "</li>";

$this->pagination->initialize($config);

$data['records'] = $this->db->get('spareparts_view',

$config['per_page'], $this->uri->segment(3));

$data['section'] = "Maintenance";

$data['subtitle'] = "Spare Parts";

$data['page_title'] = "Cold Chain Spare Parts";

$data['module']="spareparts";

$data['view_file']="list_spareparts_view";

$data['user_object'] = $this->get_user_object();

$data['main_title'] = $this->get_title();

echo Modules::run('template/'.$this->redirect($this->session-

>userdata['logged_in']['user_group']), $data);

}

57

function update(){

$update_id= $this->uri->segment(3);

$data = array();

$this->load->model('mdl_spareparts');

if (!isset($update_id )){

$update_id = $this->input->post('update_id', $id);

}

if (is_numeric($update_id)){

$data = $this->get_data_from_db($update_id);

$data['update_id'] = $update_id;

}

$data['section'] = "Maintenance";

$data['subtitle'] = "Spare Parts";

$data['page_title'] = "Update Cold Chain Spare Parts and

Accessories";

$data['module'] = "spareparts";

$data['view_file'] = "update_spareparts_form";

$data['user_object'] = $this->get_user_object();

$data['main_title'] = $this->get_title();

echo Modules::run('template/'.$this->redirect($this->session-

>userdata['logged_in']['user_group']), $data);

}

8.4 Appendix D: Central Vaccine Store Site Visit

Figure 8-11: Part of the research team during the Central Vaccine Store site visit