Factors Affecting Availability of Essential Medicines among Community Health Workers in Ethiopia, Malawi, and Rwanda: Solving the Last Mile Puzzle

Abstract

To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation.

Do community health workers perceive mechanisms associated with the success of community case management of malaria? A qualitative study from Burkina Faso

“…This may have amplified the weight of this factor in our results. However, located at the very end of the supply chain, CHWs are the most prone to endure stock-outs (Chandani et al, 2012). Drug shortages remain a major problem after the prolonged shortage, as a workshop we held in Kaya in November 2013 with CCMm stakeholders confirmed.…”

Community-based health care is an essential component of a resilient health system: evidence from Ebola outbreak in Liberia

“…Supply chain management is another critical component for successful iCCM implementation; drug stock outs reduce program effectiveness and acceptability [22, 23]. The interruption in supply of medicines was identified by CHWs as one contributor to the decrease in diarrhea and pneumonia cases treated, despite project efforts before the outbreak to establish accessible supplies.…”

“…Without close supervision it is not known to what extent medicines were used for other purposes (e.g., treatment of adults). Improving product availability at resupply points as well as the supply chain knowledge and capacity among CHWs and their supervisors is recommended [22]. …”

Oromia Bölgesel Devleti Doğu Shewa, Etiyopya’daki sağlık tesislerinde en önemli temel ilaçların envanter yönetimi performansı

“…The major reasons identified for stock out rate in the present study were inadequate supply of medicines (27.7%), stock out at re-supply point (30.9%), because of medicines expiration (26.8%) and order changed at the re-supply point (18.9%).Similar reasons were identified by the study done in south Africa which indicated that receiving in near expiry date was the main reason (61.1%) and the survey done by Yasmin Chandani et.al on factors affecting availability of essential medicines in Ethiopia, Malawi and Rwanda identified that stock out at resupply point in the three countries was one of the cause for stock out at health facilities and also one of the study conducted in Malawi to assess the deficient supplies of drugs for life threatening diseases in an African community reported that the main reason for the shortage of drugs at the health centers was insufficient deliveries from the regional medical store [23][24][25] .…”