A Manager’s Tool to Improving Community Health Supply Chains

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By Sarah Andersson, SC4CCM Country Technical Manager

 

Manager's Tool cover slideOn November 21st 2013, 21 participants from 11 sub-Saharan African countries met in Addis Ababa to participate in the first SC4CCM’s Manager’s Tool Workshop. The Manager’s Tool, which was the focus of the workshop, describes the SC4CCM project’s experiences in Malawi, Rwanda and Ethiopia and walks participants through a process of exploring how these experiences might be applied in their country or context.

The participants came from West, East and Southern African countries and either had an interest in supply chains and/or an interest in making sure community health workers (CHWs) have products when they need to treat sick children. At the beginning of the workshop participants shared information about their CHW programs and we learned about the variety of CHW programs that exist, from the Community Health Extensions Workers or CHEWs in Nigeria to the Agente Polivalente Elementares or APEs in Mozambique to the Volunteer Health Workers or VHWs in Tanzania. The differences in required background and assigned responsibilities of people lumped into one cadre, CHWs, was striking. We learned about the different levels of education, different places they work, that some are paid while others are volunteer and some manage many products while others only manage a few.  The SC4CCM countries also described their very different CHW programs: in Malawi the CHWs are called Health Surveillance Assistants (HSAs); HSAs are paid, and manage about 19 products. In Rwanda CHWs are volunteer; they work from their homes and manage about 4 or 5 products. In Ethiopia, the Health Extension Workers (HEWs) are paid, work from a Health Post and manage about 55 products. As the project works in three countries with very different CHW programs, the participants from other countries were able to find at least one of the SC4CCM countries to relate to. And common across all countries was the challenge of getting products consistently to CHWs.

Manager's Tool arrowsThe Manager’s Tool talks about three essential elements to making the supply chain function – product flow, data flow and effective people – and uses the SC4CCM innovations to show ideas on how to make each of these elements work at the community level. In product flow, the benefits of a demand based system compared to a fixed quantity system were discussed and the necessary prerequisites to implementing and maintaining such a system outlined. In data flow the importance of data visibility was highlighted and the example of cStock, a mHealth reporting and resupply system, in Malawi was presented as the most effective way to obtain timely and accurate data for supply chain decision making. For those countries not ready for mHealth, the simple resupply procedures from Rwanda were shown as a viable alternative to promoting data flow. To make people more effective so that the system could function and be sustainable, the importance of management, teamwork and motivation was highlighted. Examples were shared from all three countries: the Ready Lessons and Problem Solving in Ethiopia, the Quality Collaboratives in Rwanda, and the District Product Availability Teams in Malawi. The innovations in all three countries have the common theme of promoting teamwork among CHWs and their supervisors to work together to solve supply chain problems and improve overall supply chain performance.

Presenting real life experiences in testing innovations in each country and having representatives from these countries at the workshop to share the successes and challenges with the other participants provided a forum for a rich discussion and exchange of ideas. Everyone at the workshop was very open about the challenges they face and very willing to learn from other countries. Participants from all countries were enthusiastic to adopt some of the innovations used in making a success story for Malawi, Rwanda and Ethiopia and left the workshop motivated to go back to their countries and advocate for action to be taken to strengthen the supply chain for CHWs.

As we know, CHWs play a critical role in helping to save the lives of sick children by diagnosing and treating the children close to home. While thousands of trained, committed community health workers strive to ensure that sick children can get the treatment they need close to home, often the supply chains  cannot consistently deliver these low-cost medicines to the community level. Investing in proven strategies, such as those outlined in the SC4CCM Manager’s Tool, to improve community health supply chains is critical for achieving better child health outcomes. Click here learn more about the Manager’s Tool.