CLICK TO ADD
The 6th Global Health Supply Chain Summit
TITLE
Use of mobile image recognition software and other
efforts to improve supply chain management of key
health products for community-based distribution in
Mozambique
[SPEAKERS NAMES]
[DATE]
Joseph McCord, USAID | DELIVER PROJECT
November 18 -20, 2013
Addis Ababa, Ethiopia
Community Health Workers (CHWs) in
Mozambique Provide a Life-Saving Health
Service
In Mozambique, select districts
have 25 community health workers,
known as APEs who provide health
education, disease prevention, and
disease treatment to estimated
catchment areas of 500 to 2,000
Mozambiquans in rural areas
An uninterrupted supply of health
commodities is a critical component
of the success of CHW programs
(CORE Group 2010)
APE Activity Background
Objective: Design and pilot community health worker supply chain
interventions to address:
• Product availability
• Program supply chain visibility
General Approach:
May 2012 – Formal survey
Nov-Dec 2012 – Implementation trainings in two districts (tot. ~50 APEs)
Dec 2012 – May 2013 – Bimonthly monitoring and supervision
June 2013 – Endline survey
The field implementation of these activities was conducted through the
USAID | DELIVER PROJECT Task Orders 4 and 7, through its
subcontractor, VillageReach, with the involvement of MISAU staff and
partners at the national, provincial and district levels, and with support from
a Gates Grand Challenges grant.
APE In-Country Supply Chain (Maputo Province)
(DRAFT)
Program Plans
MISAU
CMAM
KEY
commodities
information
Quarterly
Delivery
Patient Treatment
Data
Facility
DPS
(Province)
Monthly
Aggregated monthly report Pick up or
delivery
SDSMAS
(District)
Monthly
Pick up or
Delivery
Monthly report
Monthly
Pick up
Monthly
Pick up
Target Market:
500-2000 for common
ailments inc. malaria,
diarrhea
Under-5 for pneumonia
Family planning clients
Monthly
Report
APEs
Health
Center
APE Commodities
• Essential Medicines
Kit
• Anti-Malarial Kit
(30x each of 4
presentations)
• Rapid diagnostic
tests (RDTs) for
Malaria
Tested interventions were informed by a
formal survey
Identified Challenges
• Lack of standardized system
for reporting logistics data or
resupply
• Limited APE ability to track
data and store commodities
properly at their homes
• General concerns about
transport for collection and
supervision
Interventions
1.
2.
3.
4.
5.
APE training and job aid on
consumption record/report
District Supervisor training and
equipment for scanning and
processing APE consumption
reports (ODKscan)
APE training and job aid on
resupply process
APE training and job aid on
storage practices and provision
of APE storage boxes
Follow-up trainings and routine
monitoring and supervision of
the interventions
Logistics data reporting process through
ODKscan
Artesunato Supositorio
Medicamentos
Total Recebido
Stock no
no Mês
Inicio do Mês
200 mg (43-59
meses) - 1
supositorio
Supositorios
Supositorios
Número de Tratamentos
Usados
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
00000
Total
Tratamentos
Usado
Stock no Fim
do Mês
Ruptura de
Stock
Durante o mês houve
falta de algum
medicamento
(marcar com um x):
Sim □
Supositorios
Não
1. APE records opening stock, amount received
2. During month, APE fills one bubble for each treatment
dispensed
3. APE records treatments dispensed, closing balance,
and whether they experienced stockouts
4. At end of month, APE submits completed form
□
Logistics data reporting process through
ODKscan
District
supervisor
receives reports
and uses
ODKscan to:
• Take picture of
report
• Review each
data point
• Submit CSV
file with
accompanying
pictures to
online
database
Logistics data reporting process through
ODK scan
Results: APEs and their supervisors
achieved an average on-time, complete
reporting rate of 68%
Month
December
January
February
March
April
May
Total
Manhiça Marracuene
59%
39%
55%
78%
73%
78%
68%
87%
55%
82%
59%
86%
61%
75%
Total
49%
67%
76%
78%
64%
73%
68%
• Results were likely aided by follow up trainings and targeted
supervision
• No other incentive was provided to APEs
Data quality varied by commodity and
regimen
When measuring internal consistency of the ending stock
calculation:
• For 17 out of 21 listed commodity regimens, internal
consistency was above 80%
• For 3 regimens, it was less than 20%
– Non availability of some regimens resulted in treatment
protocol lapses
• Data quality could probably be improved through
simplification of the form
District supervisors successfully
supported the logistics reporting process
District supervisors in the two test
districts:
• Processed all complete forms they
received
• Successfully maintained the hardware
and software (except for one month in
which one phone had battery
problems)
• Required on average 10-13 minutes to
process each form, spread over 1 to 2
work days per month
• Believed that the data was valuable, as
it provided an accurate perspective of
APE commodity use
Photo credit: VillageReach 2013
Resupply process and basic storage
trainings did not result in demonstrable
differences
• Resupply approaches varied in both test and control
districts
• Adherence to storage best practices was observed in all
districts
• Temperature readings inside storage boxes provided to
APEs did indicate potential benefit, but with a limited
sample
Temperature inside Temperature in
storage box (C)
drug storage
room (C)
21
25
25
26
25
28
Activity results provide implications for
CHW supply chain strengthening within
and beyond Mozambique
• Community health workers in Maputo Province in Mozambique
are fundamentally capable of recording and reporting logistics
data within a short implementation period
• Further expansion within Mozambique should include more
support for data use at the district level, more guidance for APEs
facing stockouts, and additional testing of durable boxes for
commodities
• APEs in Maputo Province accessed and dispensed commodities
despite numerous supply and programmatic challenges
• The ODK application offers a demonstrated medium for rapidly
achieving near real-time visibility into APE consumption and
stock status
Where to learn more
Dell, Nicola, Jessica Crawford, Nathan Breit, Timoteo Chaluco, Aida Coelho, Joseph McCord
and Gaetano Borriello. 2013. Integrating ODK Scan into the Community Health Worker Supply
Chain in Mozambique. Accepted for Presentation at Information Communication Technology for
Development Conference, Cape Town, South Africa (December 2013).
USAID | DELIVER PROJECT, Task Order 4. 2012. Mozambique: Strengthening the Community
Health Worker Supply Chain. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 4.
USAID | DELIVER PROJECT, Task Orders 4 and 7. 2013 (forthcoming). Mozambique:
Strengthening the Community Health Worker Supply Chain: Final Report. Arlington, Va.: USAID
| DELIVER PROJECT, Task Orders 4 and 7.
USAID | DELIVER PROJECT, Task Orders 4 and 7. 2013 (forthcoming). Data Capture at the
Community Health Level Yields Logistics Visibility. Arlington, Va.: USAID | DELIVER PROJECT,
Task Orders 4 and 7.
deliver.jsi.com
villagereach.org
ODK: http://www.youtube.com/watch?v=drbdICgJOhI