Digitalizing Uganda’s health supply chain system through an integrated solar-powered infrastructure at hard-to-reach health facilities

BACKGROUND: The Electronic Logistics Management Information Systems (eLMIS) have been adopted to track health commodity transactions. Yet challenges including limited or no connection to power grid, and internet connectivity continue to persist affecting eLMIS implementation. From a 2020/21 eLMIS Uganda assessment, 73% and 61% health facilities had no connection to internet and main electricity grid respectively. Hence an integrated infrastructure using renewable energy and powerful networking technology was adopted for commodity data tracking and visibility in health facilities not connected to the national power grid with no/weak internet connectivity in Uganda. We describe how the infrastructure improves commodity data visibility in remote facilities and compares to conventional hardware in cost. METHODS: A modified, 7-step approach by United Nations Sustainable Development Group was used to guide infrastructure installation. Infrastructure was rolled-out in 10 sites in Yumbe District, Uganda. Data on system uptime (consecutive number of days per month that solar power, internet network connectivity, and handheld terminal access was available), data synchronization (transmission) rates into the national data warehouse and deployment costs were analyzed. RESULTS: Between January 2023 and June 2024, system uptime was high at 98.9% across all 10 sites including district infrastructure used for monitoring purposes only. Data synchronization rate from the nine facilities was 82% above national average of 42% for other eLMIS. Remote support successfully resolved 57% of issues including hardware replacement. Challenges namely enhanced infrastructure at some facilities required National Product Catalogue adjustments. Deployment cost estimate for solar-powered infrastructure and conventional hardware across a five- year period, was USD 9,000 and USD 16,500 respectively for a facility III with 10 service points. CONCLUSION: The results demonstrate that use of integrated solar-powered infrastructure enhance commodity digital data capture and transmission in remote facilities by utilizing reliable renewable energy and powerful network. The lower deployment costs, remote “over the air” support, and high performance support the inclusion solar-powered infrastructure in developing countries digital health policies and scale-up plans. More research is required to establish performance on a more complex facility wide end to end digital scale and detailed cost-benefit analysis to provide in-sights on potential return on investment.