Malawi

CCM is provided by Health Surveillance Assistants (HSAs) who are a paid cadre of community health workers introduced in 1970′s, traditionally for environmental health activities. Since 2008, over 3000 HSAs located in hard to reach areas have been trained to provide CCM, in addition to other preventive services. HSAs manage up to 19 different commodities.

SC4CCM partnered with the Malaria Alert Center to conduct the baseline assessment in May–June 2010. The baseline data, confirmed by a data validation workshop, points to two major drivers of product availability at the community level:

  • product availability at the resupply point, and
  • transportation between the resupply point and the HSA.

To address these bottlenecks identified in the baseline assessment, the project developed a Malawi specific TOC aimed at measuring the impact on availability of health products of the following two interventions:

Customer Service Oriented Supply ChainsThe Efficient Product Transport intervention addresses transportation and data visibility challenges between resupply points and HSAs and is aimed at significantly improving product availability at the HSA level with a minimal expenditure of time and effort. Learn More

This intervention aims to minimize travel time by HSAs purely for the purposes of collecting supplies, simplifies and automates the resupply process, lessens the volumes that must be transported and enhances the reliability of bicycles. Following are the three key components to achieving an efficient transport system for HSAs:

  1. A continuous review inventory control system that is flexible and aligned to the routines of the HSAs; allowing HSAs to collect smaller more frequent top-up orders during their scheduled visits to reduce the requirement for the HSA to make a special trip to pick up products.
  2. An SMS-based reporting and resupply system (cStock) that calculates resupply quantities automatically for health centers and allows for data to be available in advance of the HSA arriving to pick up products.
  3. Regular bicycle maintenance performed by HSAs that reduces the break downs and repairs needed to keep the bicycles functioning, resulting in more consistent and reliable transport. HSAs are trained in the skills and provided with the tools necessary to maintain their bicycles.

The Enhanced Management intervention aims to create a customer service oriented supply chain, by developing teams that have a sense of urgency around maintaining consistent product availability for HSAs commodities, and empowering them with data and decision making authority to significantly improve product availability at the HSA level. Learn More

This intervention is based on the premise that a synergist team approach for improving product availability will have greater outputs than what individuals could achieve alone. The intervention focuses on:

  • Promoting and fostering a team vision and commitment to community health product availability among MOH staff at all levels of the product supply chain
  • Promoting supply chain goal setting, performance monitoring, and recognition of superior performance to enhance effective team performance
  • Improving communication and collaboration among team members bound by a common goal, and
  • Promoting the use of data to guide timely problem solving and decision making at district and lower levels to solve supply chain issues.

Underlying these two interventions is the need for data visibility for all relevant supply chain decision makers which is addressed through the introduction of cStock, an SMS and web-based resupply and reporting system. Learn More

Deploying a system to improve data visibility as a core component within each of the above interventions recognizes the importance of providing decision makers at higher levels of the system with more accurate and timely data with which to make supply chain decisions, and facilitating the decision making process by translating data into performance reports that can readily be used for effective decisions and actions. Examples of the kinds of decisions that will be enhanced by having better, timelier data available include:

  • Automatic calculation of resupply quantities and data available in advance of the HSA coming to collect supplies will reduce the wait time and burden on the health center staff who can organize supplies ahead of the HSA arriving
  • Timely ability to identify and respond to emergency stock levels and stockouts at the health center or HSA levels
  • Development of more comprehensive quantification and supply plans for CCM and other community health level products, using stock on hand and calculated consumption data from the HSA level.
cstock dashboard

The cStock dashboard shows CCM supply data online