This document provides an overview of the Supply Chain and Health domain overlap. This was discussed on the 18 May 2018 Supply Chain Call. Both the Health and Supply Chain domains define metadata for locations, health workers and terminologies. At the high level, there appears to be great overlap, but when we get down to the details, the field level detail is different. This document focuses on identifying these differences to drive the discussion moving forward.

Definitions

Commodity - A commodity is a good that can be consumed.

Dispense - This is an action that captures giving the commodity to the patient. In the case of immunisations, this is a shot in the arm, in the case of oral medications, this is the transaction that gives the medication to the patient to take at another time.

Wastage - See the section below titled Differing Definition of Wastage

Independent Domains and Overlap

This section provides the high level view of the domain overlap:

Health Workers

Both the Health Domain and Supply Chain need to adequately represent health workers. OpenHIE follows the WHO definition of health workers which are "all people engaged in actions whose primary intent is to enhance health." (Source) This definition is critical to define the overlap because the health workforce includes both Health Service Providers and Health Management and Support Workers allowing us to define individuals in the supply chain as Health Workers. The following table provides some examples from each domain:

Each of the Supply Chain domain personas aren't historically tracked in the OpenHIE Health Worker Registry, but they each play a role in the approval and delivery of commodities throughout the health system.

Action: Review the HWR profile and identify if the supply chain personas (Sample Profile Source) are appropriate to be tracked at the country level.

Geographic Hierarchy

Both the Health and Supply Chain domains represent the geographic hierarchy in multiple ways. Both systems recognize administrative levels of hierarchy including national, province, district, zone, village, etc. These hierarchies are used by both domains to identify locations. However, each domain identifies differing levels of geographic hierarchy with specific specialization and catchment areas.

Each location within the particular domain sits within the administrative hierarchy and the respective domain specific hierarchy.

Action: Review mCSD specification to see if it can handle different hierarchy definitions for a particular domain

Locations

Work in Progress

Commodity/Products/Trade Items

Work in Progress

Differing Definition of "Wastage"

The health and supply chain have a different definition of wastage when it comes to medical commodities:

Supply Chain Domain - The Supply Chain domain focuses on delivering a particular commodity to the point of service with the focus on ensuring that the commodity is available to be dispensed when the health worker needs it. As soon as the commodity is opened to be dispensed, the supply chain considers the commodity completely used for it's intended purpose. Any wastage that takes place up to that point is considered "Wastage" by the supply chain. This is also referred to as "Closed Vial Wastage" in immunisation programmes. An example of closed vial wastage would be if a vial of BCG fell and broke before it was opened.

Health Domain - The health domain considers wastage at a level lower than the supply chain because they are primarily focused on ensuring the commodity is appropriately dispensed to the patient. The health domain tracks wastage if there are doses available that have not been dispensed to a patient. In the immunisation programme, this is commonly referred to as "Open Vial Wastage", which is an available dose of an immunisation that wasn't injected into a patient's arm. An example of open vial wastage is if a 20 dose vial of BCG is opened, but only 5 children showed up on a particular day. In this case, 15 doses of BCG would be wasted because they were available, but were not properly dispensed to a patient.