OpenBoxes: Open Source Supply Chain Management for Global Health

One of the most intractable challenges affecting health care in low-resource and remote environments is stock out of essential medicines and supplies. Stock outs regularly result in injury or death to patients, and they are uncomfortably common. Partners in Health has made a commitment to radically reduce stock outs across all supported facilities, and OpenBoxes has been a key tool in this effort. Stock outs are caused by a variety of factors, and not all of them are within our control. However, we can endeavor to collect data on the supply needs of every facility, and use that data to procure adequate supplies to serve the population. In most cases, supply data in remote locations is entered entirely on paper. Even in Central Medical Stores, paper or spreadsheet-based tracking mechanisms are common. OpenBoxes allows organizations to track not only the consumption at each facility in the network, but also the pipeline within that network, and the quantity needed but unfulfilled for each facility. This level of data allows for more accurate forecasting and purchasing, and identification of issues contributing to stock outs..

OpenBoxes is used by NGOs and governments in 12 countries to issue purchase orders, track inventory, and manage distribution of supplies for health facilities and health networks. OpenBoxes enables health organizations to:

• issue purchase orders and report on historical purchase information;
• track goods from purchase order through shipment, receipt, and invoice;
• manage inventory, including lot and expiry tracking and bin location tracking;
• manage distribution to and within health facilities using custom stock lists;
• track stock requests and calculate true demand based on request data;
• generate forecasts incorporating orders, expected ship dates, inventory, and demand;
• connect directly to the database to develop and disseminate custom reports.

OpenBoxes is available for free to any organization that finds it useful, and PIH and creator Justin Miranda dedicate time to solicit feedback from the larger community and provide limited free support services. PIH also directly supports its own implementations of OpenBoxes in six countries, and the implementations of Pivot, Health Equity International and the MoHSS of Dominica. The longest running implementation of OpenBoxes is at Hôpital universitaire de Mirebalais in Haiti, which piloted the software in 2012 and continues to use it today.

Despite the importance of good supply management, there are relatively few affordable solutions for LMIS (Logistics Management Information Systems). There are a wide variety of commercial options (SAP, Epicor, Navision), but they are all designed for US corporate environments, and are not affordable, lightweight, user-friendly, or specialized for healthcare. Within the Open Source world, solutions like OpenLMIS and Odoo provide affordable services that are adapted to low-resource contexts. There are also many last-mile applications that do simple mobile inventory tracking or community health workers and clinics. What OpenBoxes offers is different from yet complementary to those solutions. OpenBoxes is a tool designed specifically for large, centralized global health organizations. This means that it fills a market gap between the “last-mile” solutions and the for-profit “enterprise” solutions. OpenBoxes is designed to be used within a large, centralized network of non-profit or public hospitals and clinics. It contains the purchasing, picking, and shipping functionality required for a Central Medical Store AND the distribution functionality required for a hospital or large clinic. It also contains demand calculation and simple forecasting abilities, which normally require separate software. As an integrated cloud solution, it can successfully serve the needs of a CMS and all tertiary and district hospitals on one network, while integrating with a last mile solution for remote facilities. While last mile supply chain is incredibly important, there are many tools seeking to serve that market. OpenBoxes is seeking to serve the supply managers and central planners for a country, who desperately need access to data and analytics to be successful in their roles, but who are often using the same limited tools as staff at a remote health facility.