Asia and Pacific

Tupaia: Open-source Data Aggregation, Analysis and Visualisation Platform

2021-01-29 15:04:11 sisd 64
Introduction

Tupaia is an open-source data aggregation, analysis and visualisation platform that pulls data from multiple sources including DHIS2, mSupply, Tamanu and our own MediTrak app.

Tupaia is a multi-country project that works to map health systems in the region, strengthen services and help governments fairly distribute resources. Tupaia has developed a free, easy to use, interactive online map that gives a bird’s eye view to decision makers, health workers, donors and members of the public on medicines, equipment, infrastructure, staff and services.

Tupaia teams collaborate with ministry of health staff to visit health facilities in partner countries.

Objective of the practice

Overview
Tupaia is an open-source data aggregation, analysis and visualisation platform that pulls data from multiple sources including DHIS2, mSupply, Tamanu and our own MediTrak app.

Until now, countries have found it difficult to aggregate, visualise and share information amongst key stakeholders. All countries have done sporadic, cross-sectional data collection activities at different times, but these are expensive, and the data has not regularly been made widely available. Fully functional, secure, in-country databases are also rare, and it has been difficult for a wide range of stakeholders to efficiently access the information. Tupaia aims to address all these problems.

We integrate epidemiological, medicines supply chain and health information system data to ensure that as much information is shared on the Tupaia platform as possible. Secondly, our mapping teams, led by local pharmacists in the Pacific, collect baseline data from clinics, health centres and hospitals on all the information that we need to know – does a clinic have electricity? When was the last time the staff received clinical training? Has the building been damaged in a recent disaster? Key stakeholders can view all this aggregated data at www.tupaia.org

At the same time, we have released a mobile version of the stock management software (mSupply) that each of these countries use, so that clinics can track and order stock from the warehouse using a tablet computer.

With the support of DFAT, this program, mSupply Mobile has been released open-source around the world, so that users in any country can immediately begin using this innovative tool for free. More recently, Tupaia was released open-source, so countries can access this tool for free, or collaborate to the project by customising the code to meet local needs.

Relevant SDGs
1. Sustainable Development Goal 3 – Ensure healthy lives and promote well-being for all at all ages.
Tupaia aimed to improve health services and help to target resources through improved data availability and visualisation. Tupaia has facilitated the sharing of critical information from health facilities between countries, donors and other stakeholders.
2. Sustainable Development Goal 6 – Ensure availability and sustainable management of water and sanitation for all.
The Tupaia project has captured data on the availability of water, drinking water, type of toilet, availability of water purifying tablets and alcohol hand wash across health facilities in all participating countries. This information is shared openly so governments, donors and other stakeholders can allocate resources to where they are needed most.

3. Sustainable Development Goal 17 – Strengthen the means of implementation and revitalise the global partnership for sustainable development
Tupaia has facilitated collaboration across six governments with stakeholders including Australian Aid, DFAT innovationXchange, mSupply, World Health Organisation, The World Bank, Marie Stopes International, UNICEF, Bill and Melinda Gates Foundation, New Zealand Foreign Affairs and Trade, and more.

Key stakeholders and partnerships

The project is currently implemented in Solomon Islands, Tonga, Kiribati, Tokelau, Vanuatu and Cook Islands. Governments, Ministries of Health and key local staff were critical to the success of Tupaia.

Tupaia is funded by the Australian Government’s innovationXchange program. The innovationXchange portfolio of investments fall broadly under inclusive economic growth, health, water and humanitarian assistance.

Sustainable Solutions is a New Zealand based company with offices in Auckland and in Kathmandu, Nepal. First developed nearly 20 years ago, their mSupply software is used in over 30 countries worldwide.

Implementation of the Project/Activity

Approach
Tupaia syncs data from existing platforms in each country. These currently include mSupply (stock management), Tamanu (Electronic Medical Records) and DHIS2 (epidemiology). In addition, Tupaia syncs information collected during baseline mapping from our own free data collection app (Tupaia MediTrak).

We have subsequently worked with donors and DFAT post in each country to raise awareness of the platform and encourage different usage cases; these may include tracking the availability of reproductive health commodities or vaccines, disaster response or identifying the availability of service provision across countries. The biggest focus of data usage has been on improving medicines availability and we have worked with health supply chain managers in each country to facilitate this, applying data for decision making. Some of these activities are described in this report.

Surveys conducted at baseline:
- WHO HeRAMS survey (disaster preparedness)
- SARA (Service Availability and Readiness Assessment)
- Facility Fundamentals
- Basic Clinic Data
- World Bank Facility Finance assessment tool

mSupply Mobile
mSupply is a Logistics Management Information System (LMIS) used for stock management of health supply chains in over 30 countries around the world. mSupply is used in most Pacific Island Countries (including all Tupaia countries), as well as Asian countries such as Myanmar, Laos and Cambodia. mSupply is available in desktop and mobile (android tablet) versions.

Through the Tupaia project, DFAT made mSupply Mobile open-source. The justification for this was that it would make this world-leading technology available to more facilities, in more countries, much faster. This has been leveraged in the first 12 months alone, so that mSupply Mobile has been installed in 200 facilities across 7 countries since the commencement of Tupaia. Existing agreements are in place to further expand mSupply Mobile into Cambodia and PNG, whilst there is potential to expand into Myanmar, Laos, Cote d’Ivoire and Sierra Leone over the next 12 months.
mSupply Mobile has been implemented directly using Tupaia funding in 30 facilities in Kiribati, 14 facilities in Tonga and 7 facilities in Vanuatu during Phase 1.

Health system strengthening
Tupaia aimed to improve health services and help to target resources through improved data availability and visualisation. Where possible, we have also provided training and other technical support in health supply chains during the initiation phase.

Results/Outputs/Impacts

Medicines Availability
Medicines availability has risen across the region. Tupaia.org went live in July 2017. From August 2017, to May 2018, medicines availability across all Tupaia countries in the region increased from 58% to 72%. Of course, these increases cannot be solely attributed to Tupaia, the timeframe is too short and there is no control group to measure against. Nevertheless, this is a hugely encouraging trend.

Disaster Response
The disaster response functionality was utilised in Tonga following Cyclone Gita. This showed within 48-72 hours of the disaster that health facilities had been relatively undamaged. This information was used to determine that resources should be targeted towards communities and that international response teams on standby could be stood down, resulting in a potentially significant cost saving.

Partnerships
The facility financing tool has been used by World Bank in Kiribati to inform planning on regional health security.

Improved communication
By far the most unexpected and pleasing outcome has been around the development of a community of health-workers in communication with each other. In Kiribati, Tonga, Timor-Leste and elsewhere, we installed Telegram (a messaging app similar to WhatsApp) to facilitate peer-to-peer training on how to use mSupply Mobile and Tupaia MediTrak. Those networks have grown into incredible communication channels for a variety of uses, including supply chain information (“when is X ship scheduled to depart Y”, “is anyone travelling to Z this week”), clinical support (“I have a patient suffering X, can someone provide advice”), patient referrals and software troubleshooting.

In Kiribati alone, across 30 sites, over 3000 messages each month are being exchanged. Similar numbers are being seen in Tonga. If the project’s sole purpose had been to establish a health worker communication network, it would almost have been worth the investment!

Key statistics
The implementation of Tupaia has been outstanding across the pacific. Some of the highlights are listed below.
• 6 countries
• 7,000 surveys completed
• 600 facilities mapped
• 360 registered data collectors
• 3,000+ website users
• 500,000+ data points

Program area example: Reproductive health
Tupaia allows individual program areas to track relevant metrics of service provision or commodity availability. This allows them to target scarce resources to facilities and areas that most need them. Within reproductive health for example, users can track the availability of contraception commodities (condoms, OCPs, injectables, inserts and other devices), or run map overlays of available services (such as antenatal care, STI testing and treatment, male circumcision, or deliveries).

Enabling factors and constraints

Seed funding
DFAT Innovation Exchange committed seed funding for Tupaia in collaboration with software providers mSupply and their partners Beyond Essential Systems to transform the availability of medical supply information in up to six participating partner countries in the Pacific region.

In country partnerships
Utilising the established networks of local pharmacy divisions/departments within the Ministries of Health to undertake baseline mapping worked spectacularly successfully. Mapping of hundreds of health facilities was conducted by trained health workers (pharmacists, pharmacy officers and nurses) rapidly and cost-effectively. Other facility-touring programs over the years have become bogged down trying to visit large numbers of health facilities and these are usually extremely costly exercises.

Working with Pharmacy staff proved cheap and data collection was generally of high quality. Pharmacy divisions are a largely untapped resource in most Pacific Island Countries – they have a strong knowledge of existing supply chains (including local geography and logistics), they work across all health programs and they are often distributed across island chains, provinces or districts.

Sustainability and replicability

Sustainability has been a core focus for the Tupaia project.

Free and open-source
Tupaia and mSupply mobile are now both free and open-source solutions. We believe this aspect of the project is critical to its ongoing success. Some of the benefits include:
1. Handover from donors to country after initial implementation is easy
2. Source code is freely available, allowing software developers around the world to customise and contribute to the project at no cost.
3. Ongoing maintenance contracts can be awarded to other local or international agencies. This ensures countries are not bound to expensive maintenance contracts and poor support from the initial supplier.
4. IT leaders must fundamentally provide flexibility and agility for their enterprise. Open source enables technology agility, typically offering multiple ways to solve problems. Instead of waiting for the vendor to deliver that capability, you can create it yourself.
5. Open source is the future. Web, mobile, and cloud solutions are increasingly built predominantly on open source infrastructure. Some data and analytic solutions are only available in open source.

Future projects
The replicability of Tupaia is evidenced by additional projects added to the initial scope of work for Tupaia. Following the initial software development and health facility mapping, several projects were added, including:
• Implementation of mSupply Mobile in 30 sites in Kiribati
• Server consolidation and fibre optic connection to CPMS in Tonga
• Implementation of Tupaia and mSupply Mobile in Cook Islands
• Development of assessment tool for the Package of Essential Health Services in Tonga
• Implementation of mSupply Mobile in 9 sites in Tonga
• Implementation of mSupply Mobile in 7 sites in Vanuatu
• Implementation of Tupaia and mSupply Mobile in Tokelau

Conclusions

Tupaia has been an incredibly successful project, particularly when assessed against the 2030 Agenda for Sustainable Development.

We believe that Tupaia has contributed to the following Sustainable Development Goals over the last two years.
1. Sustainable Development Goal 3 – Ensure healthy lives and promote well-being for all at all ages.
2. Sustainable Development Goal 6 – Ensure availability and sustainable management of water and sanitation for all.
3. Sustainable Development Goal 17 – Strengthen the means of implementation and revitalise the global partnership for sustainable development
In addition to highlighting the three goals above, we are particularly keen to highlight the following project statistics.
• Tupaia, Tamanu and mSupply mobile currently free and open source.
• Medicines availability has risen across the pacific during the project. From August 2017, to May 2018, medicines availability across all Tupaia countries in the region increased from 58% to 72%.
• Tupaia implanted in 6 countries
• 7,000 surveys completed across 600 facilities mapped from 360 registered data collectors
• 3,000+ website users and 500,000+ data points