Background: The Zambian Ministry of Health faced many challenges in managing procurement and distribution of medical products and supplies. Long lead times, stockouts, and general lack of efficiency characterized the in-country supply chain.
Description: In 2014, USAID implementing partners began working with the Zambian Government to pilot and scale up an electronic Logistics Management Information System (eLMIS). This open-source software facilitates data collection in low-infrastructure environments for review, aggregation, analysis, and forecasting by incorporating a wide range of systems (medical records, laboratory data) and enabling data visibility from point of origin to point of delivery. The eLMIS has been deployed to seven countries.
Lessons learned: Through eLMIS, Zambia has achieved measurable improvements in logistics management, according to the eLMIS mid-line evaluation, including:

• Increased visibility of supply chain operations resulting in broader involvement of user groups for supply chain decision making: User sessions in eLMIS increased by 149% between May 2015 and January 2018
• Increased throughput of health commodities to support WHO universal test-and-treat strategy (UNAIDS 90-90-90 goals): Increased use of HIV test kits by 141% and ARVs by 254% between the start of 2015 and end of 2016
• Improved health care service delivery resulting in reduced missed treatments and better patient adherence to treatments: Expired products at sites reduced by 80% between March 2016 and February 2017; ARV availability at sites increased by 20% since 2015
• Potential reduction in supply chain supervision costs: Targeted supervision visits conducted to easily identifiable problem sites based on insights from data; Fostering of a cohesive experience among implementing partners, leading to improved quality and lower costs of intervention.

Conclusions/Next steps: Electronic information systems require allocation of resources and time to achieve sustainability and attain the full change management maturity model. Some challenges persist in Zambia; there is a need to continue cultivating reliance on data for decision-making. Data are widely used to guide procurement and routine operational decisions, but not yet for supervision and policy development. The technology and implementation experience from Zambia will benefit neighboring countries grappling with similar challenges.

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