South-South Cooperation for a Healthier Tomorrow: The SMILE Initiative
November 7, 2024
Fostering the spirit of South-South Cooperation, Indonesia is not only addressing its own healthcare challenges but also sharing its expertise to help other nations transform their health systems. A key player in this collaborative effort is the Electronic Immunization and Logistics Monitoring System (SMILE), a digital solution designed to streamline healthcare logistics and ensure equitable vaccine distribution. By transferring this technology to countries such as Malawi, Indonesia is demonstrating the power of knowledge-sharing across the Global South.
In 2008, immunization coverage for children in Indonesia’s outer islands stood at just 73 percent, well below the global target of 90 percent. While in the easternmost regions, such as Papua and East Nusa Tenggara, coverage did not even reach 60 percent. If unaddressed, this situation could significantly impact the nation's future life expectancy.
Recognizing the urgent need for health reform, the country invested in strengthening its health infrastructure, leading to the development of SMILE. Inspired by India’s successful eVIN system, SMILE was developed by the Ministry of Health with support from UNDP. It was launched in 2018 to tackle the logistical challenges of the world’s fourth most populous nation. With, its vast archipelago, maintaining accurate vaccine distribution records was critical.
Initially intended for routine immunizations, SMILE was swiftly adapted to become an essential component of Indonesia's COVID-19 response. The system played a pivotal role in facilitating the timely delivery of 450 million of COVID-19 vaccine doses to 185 million individuals within a year. Furthermore, SMILE's efficient distribution system gradually ensured comprehensive vaccine coverage across the nation over a three-year period. This accomplishment was particularly remarkable, given that some projections indicated Indonesia would require more than a decade to vaccinate 75 percent of its population.
Today, SMILE is one of central pillars of Indonesia’s healthcare logistics infrastructure, managing over 850 million doses of COVID-19 and routine immunization vaccines, and 100 million drug doses across 12,000 health facilities in 38 provinces. Its scope has expanded to include a wide range of health commodities – covering routine immunizations, HIV/AIDS, Tuberculosis, Malaria, Rabies and medical waste management.
An economic analysis revealed that SMILE not only improves health outcomes but also generates significant financial returns, delivering threefold savings for every dollar invested in health service delivery.
Building on this success, Indonesia – through a partnership between the Ministry of Health and UNDP Indonesia with support from the UNDP Bangkok Regional Hub and the UNDP Digital Health for Development Hub – has made SMILE system available for other countries to adopt as part of an effort to promote South-South knowledge-sharing. The open-source nature of the SMILE platform allows for its local customization, making it adaptable to diverse healthcare environments.
One of the most recent beneficiaries of this knowledge-sharing initiative is Malawi. Recently, a high-ranking delegation of eight officials from Malawi’s Ministry of Health, UNDP and WHO visited Indonesia to witness SMILE’s implementation firsthand. The visit involved field demonstrations of the SMILE application in Yogyakarta’s Provincial Health Office, Gedong Tengen Primary Health Center and RSUP Dr. Sardjito, allowing the delegation to interact with health workers and observe how the system works to efficiently manage and monitor logistics for immunization, essential drugs and healthcare waste.
Addressing the Malawian delegates, the Ministry of Health’s Secretary-General, Kunta Wibawa Dasa Nugraha emphasized, ”Falls under the Indonesia’s Health Transformation Strategy, particularly the 6th Pillar; Health Technology Transformation, SMILE has extended the services to cover monitoring of vaccine logistics, medicines, disposable medical devices and waste management. The system also has been integrated into our One Health national platform, SATUSEHAT.”
Indonesia’s Ministry of Health has demonstrated its leadership and commitment by issuing a Ministerial Decree to govern the implementation and financing of SMILE on the SATUSEHAT platform. This regulation aims to ensure the system’s sustainability and effective cross-sectoral partnership. During their visit, Malawi’s delegation also met with high-ranking officials from the Ministry of Health, WHO, UNICEF, etc.
The Malawian delegation expressed deep appreciation for Indonesia’s generosity and expertise. James Manyetera, Principal Secretary of Administration at the Ministry of Health of Malawi, emphasized the value of the exchange: “Through engagement with UNDP in Malawi and Indonesia, we learned that there is SMILE, an application which is used to trace and follow real-time movement of stocks of drugs in this country. We travel to Indonesia and understand for ourselves, learn from what Indonesia has achieved. It has been a fruitful trip and Malawi is going to implement a similar program.”
Malawi now looks forward to adapting SMILE to improve their essential drugs supply chain and healthcare outcomes, especially through its E-HIN system, which is set to accelerate the country’s digital transformation in the health sector.
Manish Pant, Policy Specialist for Digital Health at UNDP, highlighted the key factors behind SMILE’s success: “The success of this system stems from Indonesia’s accumulated lessons in technology advancement, interoperability, capacity building and strategic management. SMILE is not just an application but a foundational component of a broader digital ecosystem. Malawi can draw valuable lessons from Indonesia’s experience as it embarks on its own digital health journey.”
Beyond Malawi, SMILE’s impact is resonating globally. Several countries – including Bangladesh, Haiti, Kazakhstan, Maldives, Viet Nam – are exploring opportunities to adopt and adapt SMILE to meet their local needs. This growing interest reinforces the power of South-South Cooperation in driving digital health innovation and improving healthcare systems globally.
The collaboration between Indonesia and Malawi is more than just a bilateral partnership; it represents the transformative potential of South-South knowledge exchange. By scaling up digital health solutions such as SMILE, the Global South is actively contributing to SDG 3: Good Health and Well-being by ensuring more equitable, efficient, and resilient healthcare systems. Aligned with SDG 17, which emphasizes the importance of partnerships, the Global South is demonstrating its commitment to collaborative action in advancing global health. These efforts are crucial to building a healthier tomorrow for all.
Authors: Noor Hasibuan, Virgi Fatmawati, Ian Mungall and Manish Pant
Watch the video of Malawi learning visit here:
Malawi Visit to Indonesia: Learning from SMILE on Digitizing Health Supply Chain