Malawi

CCM is provided by Health Surveillance Assistants (HSAs) who are a paid cadre of community health workers introduced in the 1960s for smallpox vaccination and have since played a critical role in addressing public health emergencies and environmental health activities. Since 2008, over 3,000 HSAs located in hard to reach areas have been trained to provide CCM, in addition to traditional  preventive services. HSAs now can manage up to 19 different commodities in their village clinics for CCM, family planning, and HIV testing. 

Enhanced Management 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 goal of increasing community health product availability among MOH staff at all levels of the product supply chain,
• Promoting supply chain 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.

Read more about Quality Improvement teams.

cStock uses basic GSM phones already owned by HSAs to report data monthly via SMS on a toll free phone line. The system calculates resupply quantities for each HSA and sends the quantities directly via SMS to the health center to prepack products. Health centers advice HSAs when stock is available for collection. A web-accessible dashboard with simple, easy-to-use reports, shows stock levels, reporting rates, and alerts for central and district level managers. Data is hosted on the Cloud, an inexpensive, reliable, and easy to manage option for a small scale system like cStock as it does not require recruiting/training IT support staff and procuring/maintaining a server.

Read more about cStock.

DPATs are comprised of district management, health center staff, and HSAs who are responsible for ensuring that community health products are available at all times for HSAs to provide services to clients. They seek to develop well performing teams with a common goal and performance plan that includes indicators and targets that can be monitored through cStock. DPATs meet regularly to monitor performance targets, recognize good performance and agree on actions to take to address supply chain challenges. 

This intervention aimed to minimize travel time for HSAs purely for the purposes of collecting supplies, lessen the volumes that must be transported and enhance the reliability of bicycles. The key components to this intervention, in addition to cStock, were:

• A continuous review inventory control system that was 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.
• Regular bicycle maintenance performed by HSAs that reduced the break downs and repairs needed to keep the bicycles functioning, resulting in more consistent and reliable transport. HSAs were trained in the skills and provided with the tools necessary to maintain their bicycles.
• Tools developed as part of this intervention included: the Bicycle Maintenance and Repair Guide Booklet, Bicycle Repair Training Guide, and HSA Bicycle Toolkit.

Midline results for the EPT intervention were not as promising so these activities were discontinued and these pilot districts have since been trained in the EM Approach.