Bringing reliable GPS tracking to health commodity distribution: Successes, challenges, and lessons learned in Cameroon, Haiti, and Niger

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New Insights Approaches: Article 1
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Date
September 1, 2022
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In this new series from GHSC-PSM, we share recent insights and lessons learned from across our country programs. In this first article, we examine GPS tracking of commodity distribution, which remains challenging in public health supply chains. GHSC-PSM is piloting the development and implementation of the Distribution, Transportation & Tracking (DTT) system in Cameroon, Haiti, and Niger to ensure a more reliable GPS tracking of health commodities. Using commercial GPS devices, a free survey tool, and an application developed in-house, DTT provides a standardized, real-time GPS tracking system for third-party logistics (3PL) providers with no cost or major action on their part. Across the three countries, 1,076 sites and their deliveries are being tracked in real time using the DTT system, including 221 3PL vehicles, 258 3PL drivers, 1,147 geofences, and 92 trackers. The DTT system can be implemented across different programs and countries to improve the efficiency and visibility of commodity distribution.
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Having GPS Doesn't Always Mean Having Visibility
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Inspired by Amazon and other well-known private-sector companies, those working in public health supply chains have aimed for several years now to provide visibility into deliveries of public health commodities using Global Positioning System (GPS) tracking. 

The USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project supports private-sector engagement to outsource key supply chain functions to sustain and advance health supply chain operations. Contracts with third-party logistics (3PL) providers include a clause that requires them to furnish GPS tracking for the distribution of USAID commodities, with the project having access to that application. However, in practice, this rarely produces the intended outcome: visibility of commodities as they move throughout the country during distribution. 

In Haiti, Cameroon, Niger, and other countries, this requirement for GPS tracking accessible to the project has proven difficult to implement. The reasons behind this failure vary but include uneven 3PL compliance and the nature of awarded contracts. For example, having multiple contracts with 3PLs can mean project staff dealing with numerous usernames and passwords and even multiple GPS tracking platforms. Moreover, it would be impossible to have total visibility of all vehicles moving during distribution. In some cases, ​​being awarded a contract is not a guarantee of revenue, and thus it may prove difficult for a 3PL transporter to increase operational costs by subscribing to a GPS service without having guaranteed income.

In 2019, while issuing a new request for proposals for transport in Haiti, challenges with access to GPS tracking platforms emerged as a critical issue. As a result, GHSC-PSM piloted the use of a US-based commercial provider of GPS tracking. After several months of implementation, the project expanded to Cameroon and Niger.

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A Customized Solution that Goes Beyond Commercial GPS Applications
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Although commercial GPS tracking solutions could provide visibility when correctly installed in vehicles, simply tracking a car or a truck is not enough for health commodities. Successful tracking also requires understanding and connecting data about the driver, the staff loading the vehicle, the destination, and information about the products, all with the final aim of improving distribution and overall supply chain performance. Initially, GHSC-PSM tested a commercial, off-the-shelf subscription-based GPS tracking service provided by a US-based company to track all 3PL vehicles and create delivery alerts for facilities. 

However, after a year of learning, trial and error, and adaptability challenges with commercial GPS tracking—including difficulties of the US-based technical support to understand and troubleshoot effectively—GHSC-PSM developed an innovative, customized solution called the Distribution, Transportation & Tracking (DTT) system, with its own internal mapping and GPS tracking modules. Since November 2021, the project has implemented this stand-alone tracking system that includes five components: 

1. commercial GPS trackers 

2. a global SIM card provider

3. a telematic data hub provider that receives all data messages from all trackers

4. an open-source survey tool: the project selected the open-source Kobo survey tool (https://www.kobotoolbox.org/kobo/) installed in staff smartphones to connect all data points

5. an in-house developed application (DTT app)

The project staff uses Kobo to register the following primary data points: the 3PL driver (with ID, license, and picture), the vehicle (type, size, and photos; then a QR code is generated and attached to the vehicle as a sticker), the staff who will eventually dispatch the commodities at the warehouse, and the GPS trackers themselves (each with a unique number embedded in a QR code).

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Registering a 3PL Driver using Kobo Survery Toolbox
Registering a 3PL Driver using Kobo Survery Toolbox
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Cubing the 3PL vehicle during inspection and registration.
Cubing the 3PL vehicle during inspection and registration
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These primary data are used to backfill the DTT app, a consolidator of information aggregating data from various sources, including different 3PL providers, facilities, and even countries. The DTT app can also visually connect the driver, truck, project staff, GPS tracker, destination, and commodities being distributed. The DTT system allows the management of all these data in one platform. Additionally, the complete suite of modules within DTT includes visual mapping, geofencing (establishing virtual perimeters defined by GPS technology that enable software to trigger a response when a tracker installed in a 3PL vehicle enters or leaves that particular area), and an alert system

During operations, the staff loading the commodities scan the QR codes of the driver, tracker, and delivery vehicle. Where access to the warehouse management system is available, the staff can access proof of delivery data, which are linked to the document by another QR code. Once they scan this QR code, the Kobo cloud synchronizes with DTT, which associates the proof of delivery and the respective primary data, allowing users to see the products on the vehicle. In this way, the DTT app receives all the data to provide real-time visibility of the tracker and vehicle.

Since the ultimate purpose of DTT is to verify that vehicles and commodities arrive at facilities, the system has established geofences “surrounding” all sites. The project staff, storekeepers, or pharmacists in charge can receive an alert via email or text message when a truck enters the geofence. Following this, the staff confirm that the truck has arrived and verifies the content, which involves several verification steps against fraud. In addition, in Niger and Haiti, GHSC-PSM staff perform and record customer service-styled post-distribution calls. 

Rather than entering into individual agreements with multiple cell network providers in each country, the project selected a global cellular data provider to transmit data from the GPS trackers and monitor data usage and payments in one single platform across all countries. Since captured data are only reference points on a map, the data exchange service is relatively inexpensive (around $150/month in global SIM cards and data across the three countries).

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Visual mapping of 3PL delivery to health facilities using the DTT app in Cameroon
Visual mapping of 3PL delivery to health facilities using the DTT app in Cameroon
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Using the open-source survery tool to connect all primary data that DTT will use during distribution
Using the open-source survery tool to connect all primary data that DTT will use during distribution
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Activities and Results Since September 2021 in each Country
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DTT is used for the tracking and delivery verification of health commodities in Haiti, Niger and Cameroon. While results vary, each country has documented a positive effect on their public health supply chains. Much of the improved performance is related to behavior change of drivers and 3PLs: Increased real-time visibility equates to increased supervision.  

In Haiti, the DTT system has been used at the central warehouse to make 563 deliveries of HIV/AIDS, family planning/reproductive health and maternal, newborn and child health commodities to 279 health facilities across the country, triggering more than 2,350 geofence alerts. 55 vehicles and 69 drivers are registered and cataloged in the system.  In addition to visual verification, the system alerts were used to initiate more than 500 customer service calls using the project's integrated call center.

In Niger, the DTT system has been used in the two regions where GHSC-PSM operates to monitor 926 deliveries of malaria commodities to more than 440 sites, with some 4,000 geofence alerts triggered. 134 vehicles and 144 drivers are registered and cataloged in the system.  In addition to visual verification, the system alerts were used to initiate more than 500 customer service calls using the project's integrated call center.

In Cameroon, the DTT system has been used in all 10 regions of the country where 3PLs were dispatched from Regional Fund (parastatal) warehouses to make 516 deliveries of HIV/AIDS commodities to more than 400 health facilities,triggering more than 4,300 geofence alerts. 30 vehicles and 45 drivers and registered and cataloged in the system.

The system presents numerous advantages over commercial GPS tracking systems: 

  • is universal and standardizable across different programs and countries, which facilitates implementation; 
  • allows management of all movements for an entire country in one platform, avoiding the technical and administrative hurdles of using different GPS tracking systems or having multiple users and passwords (if needed, a superuser could also have access to data from all countries); 
  • ensures more accountability and transparency during distribution: for example, in Haiti, tracking allowed the field office to discover that a 3PL was not reaching all agreed-upon sites and instead left commodities at neighboring sites; in Niger, the team identified a 3PL delivering off-hours; 
  • reduces commodity distribution times while ensuring more reliable distribution: in one region in Niger, from more than a month to 8-9 days; in Adamawa region in Cameroon, the regional fund used to take two months to distribute to all sites, which is now done in less than one week; 
  • improves the efficiency of the distribution process ​​by allowing full visibility of travel time and routes taken, which is expected to translate into diminished costs over time;
  • is a centralized activity with very few people actively managing the process: drivers only have to allow project staff to “plug-in” GPS trackers, while the rest is managed administratively, and only one to three staff per distribution center need to be trained, avoiding the need for constant training due to staff turnover; 
  • contributes to expanding the 3PL marketplace: since there is no monthly subscription, small businesses are more willing to bid on a request for proposals; 
  • increases 3PL staff compliance and decreases fraud by promoting a behavioral change in drivers and 3PLs in general: GHSC-PSM can allow company operations teams to access the system, so they can monitor the work of their staff; 
  • can help promote the private sector’s capacities;
  • importantly, using DTT can improve the visibility of commodity distribution and, consequently, the whole supply chain for donors and partners. This helps predict issues and understand where problems are to find solutions.
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Looking Forward: Challenges Remain
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The DTT process must still be refined in terms of time—since many manual steps are involved—and sustainability. The implementation of the DTT system is facing several challenges since it is not supported by a specific budget (current funding comes from GHSC-PSM’s budget—funded by USAID—in each country) and people involved do this while performing other duties. Therefore, how to make the system sustainable remains a crucial question and, although different pieces of DTT can be transitioned to the host country government or other implementing partner, it is unlikely the entire system can be successfully transitioned.

Some technical difficulties remain due to the limited access to technical support and troubleshooting, as the DTT application is custom-built. Also, data integration with commodity management software used at facilities could be cumbersome, since each warehouse management information system needs specialized integration to reap the full benefits of DTT. Customizing the system for each specific setting remains a crucial point. In the future, the DTT real-time tracking system could be applied to ensure that the cold chain—for COVID-19 vaccines, for example—is maintained to the last mile. This can be done by monitoring geofences for cold chain distribution and quickly identifying deliveries that are not completed according to the contract.

​Overall, the DTT system aims to build what private transportation sector players use to manage their supply chain. Since simple visuals of a vehicle on a screen are not enough in the case of health commodities, the DTT system, while still under development, is designed to provide visibility of supply chain information, providing the same quality and level of visibility as the private sector.