Strengthening community health supply chain performance through an integrated approach: Using mHealth technology and multilevel teams in Malawi.

BACKGROUND In 2010 7 6 million children under five died globally largely due to preventable diseases Majority of these deaths occurred in sub Saharan Africa As a strategy to reduce child mortality the Government of Malawi in 2008 initiated integrated community case management allowing health surveillance assistants HSAs to treat sick children in communities Malawi however faces health infrastructure challenges including weak supply chain systems leading to low product availability A baseline assessment conducted in 2010 identified data visibility transport and motivation of HSAs as challenges to continuous product availability The project designed a mHealth tool as part of two interventions to address these challenges METHODS A mobile health mHealth technology cStock for reporting on community stock data was designed and implemented as an integral component of Enhanced Management EM and Efficient Product Transport EPT interventions We developed a feasibility and acceptability framework to evaluate the effectiveness and predict the likelihood of scalability and ownership of the interventions Mixed methods were used to conduct baseline and follow up assessments in May 2010 and February 2013 respectively Routine monitoring data on community stock level reports from cStock were used to analyze supply chain performance over 18 month period in the intervention groups RESULTS Mean stock reporting rate by HSAs was 94 in EM group n 393 and 79 in EPT group n 253 mean reporting completeness was 85 and 65 respectively Lead time for HSA drug resupply over the 18 month period was on average 12 8 days in EM and 26 4 days in EPT and mean stock out rate for 6 tracer products was significantly lower in EM compared to EPT group CONCLUSIONS Results demonstrate that cStock was feasible and acceptable to test users in Malawi and that based on comparison with the EPT group the team component of the EM group was an essential pairing with cStock to achieve the best possible supply chain performance and supply reliability Establishing multi level teams serves to connect HSAs with decision makers at higher levels of the health system align objectives clarify roles and promote trust and collaboration thereby promoting country ownership and scalability of a cStock like system