Programmatic assessment of electronic Vaccine Intelligence Network (eVIN)

Abstract

eVIN is a technology system that digitizes vaccine stocks through a smartphone application and builds the capacity of program managers and cold chain handlers to integrate technology in their regular work. To effectively manage the vaccine logistics, in 2015, this technology was rolled-out in 12 states of India. This study assessed the programmatic usefulness of eVIN implementation in the areas of vaccine utilization, vaccine stock and distribution management and documentation across selected cold chain points. A pre-post study design was used, where cold chain points (CCPs) were selected using two-stage sampling technique in eVIN states. Pre-post comparative analysis was carried out on the identified indicators using both primary and secondary data sources. The vaccine utilization data reflects that the utilization had reduced from 305.3 million doses in pre-eVIN period to 215.0 million doses in post-eVIN period across 12 eVIN states, resulting into savings of approximately 90 million doses of vaccines. Number of facilities having stock-out of any vaccine showed a significant reduction by 30.4% in post-eVIN period (p<0.001). There was a 4.0% drop in facilities reporting minimum stock of any vaccine after implementation of eVIN. Facilities with maximum stock of any vaccine had increased from 37.4% in pre-eVIN to 39.2% in post-eVIN. During the pre-eVIN period, only 38.6% facilities updated vaccine stock on a daily basis, while in post-eVIN period, 53.5% facilities updated vaccine stock on daily basis. The completeness of records in the vaccine stock registers, indent form and temperature logbook have been substantially improved in the post-eVIN period (p<0.001). eVIN had helped in streamlining the vaccine flow network and ensured equity through better vaccine management practices. It is a powerful contribution to strengthen the vaccine supply chain and management. Upscaling eVIN in the remaining states of India will be crucial in improving the efficacy of vaccines and cold chain management.

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“…Health care services are provided by both public and private health care facilities. The national health infrastructure extends to the study clusters, including the universal immunization programme (UIP); Mission Indradhanush; and strengthening the Electronic Vaccine Intelligence Network (eVIN), which is a digital information system on the vaccine supply chain, stocks, and storage temperatures [32]. The National Family Health Survey-5 shows improvement in numbers of fully immunised children in the study clusters.…”

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“…This technology combines features like IT infrastructure and trained human resources which helps in stock monitoring as well as monitoring of storage temperature of the vaccines kept at different multiple locations across the country. 7 eVIN has been installed across 28,000 vaccine delivery points and is very useful in maintaining stock across the vaccine storage centres in India. Around 50,000 temperature loggers have been installed as part of this application and around 49,000 government personnel have been engaged in the management of eVIN.…”

“…eVIN technology uses the smartphone, webbased application, temperature loggers and cloud-based server to digitize vaccine stock inventory and storage temperature of all the vaccine stores and cold chain points located at peripheral government health facilities. 7 Every cold chain handler engaged in delivering immunization services enters the net utilization for each vaccine in the standardized registers at the end of every immunization day. This is simultaneously updated in the eVIN application and uploaded on a cloud server, which can then be viewed by programme managers at the district, state and national level through online dashboards.…”

“…This is simultaneously updated in the eVIN application and uploaded on a cloud server, which can then be viewed by programme managers at the district, state and national level through online dashboards. 7 Earlier studies done in the past have studied the reduction in the utilization of the vaccines, thereby saving so many doses in post eVIN period, significant reduction in the stockout at various facilities. Vaccine flow network has been streamlined and other aspects like assessment of factors affecting vaccine cold chain management practices in public health have been rationalized.…”

“…Vaccine flow network has been streamlined and other aspects like assessment of factors affecting vaccine cold chain management practices in public health have been rationalized. 7,8 But these studies have not considered the effect of eVIN app on the vaccine beneficiaries, vaccine availability and difference in the wastage. The literature was also lacking in the area of user-friendliness of this application and experiences of health care workers who are engaged in delivering immunization services and are using this application.…”