Community health staff and leaders identify stock outs and poor supply chains as a major barrier to community health programs. A lack of attention to designing appropriate and practical supply chain procedures for community health workers (CHW) coupled with poor visibility and use of logistics data to inform decision-making results in unreliable supplies of health commodities for CHWs. Ensuring CHWs have access to basic and life-saving requires purposefully designed supply chain solutions.
In Kenya, the under-5 mortality rate fell by about 50% between 2003 and 2014 from approximately 99 per 1,000 live births to 52 per 1,000 live births, a remarkable achievement (DHS 2014). However, Kenya, like many countries, faces large health disparities across regions due to inequitable access to healthcare. According to the DHS2014 “a child born in the Nyanza region (82 deaths per 1,000 live births) is almost twice as likely to die before age 5 as a child born in the Central region of Kenya”. Kenya is experiencing low health worker retention and health worker shortages of all counties, but particularly in hard-to-reach areas. Kenya’s recent Ministerial Strategic and Investment Plan (july 2014– june 2018) identified flagship projects under the social pillar of the vision 2030; one of which is fast tracking implementation of the community strategy. This community strategy requires a robust and sustainable supply chain management solution for CHWs to ensure that the program is successful.
There are only a few mobile-based supply chain solutions for CHWs that automate demand based resupply. Some programs have used DHIS2 to report logistics data, but cStock is the first to use DHIS2 to calculate supply chain indicators and predict resupply needs. By working with the University of Oslo to integrate cStock workflows and supply chain indicators in DHIS2, InSupply Health has developed a unique solution that is affordable, scalable and easily replicated for community health programs in Kenya and other countries.
Other unique elements of the cStock approach include
- System strengthening approach: the cStock approach includes a design process that considers reporting, collection, and resupply processes; defining roles and responsibilities (for CHWs, their supervisors, and the facility that resupplies them); implementing structures for data use and connecting CHWs to their supervisors and the facility that resupplies them (i.e. IMPACT teams); and ensuring technology can support all processes.
- Flexible across available hardware: the system must allow users to use whatever hardware is available to them - feature or smartphone, computers, or tablets.
- Linking reporting to resupply: supervisors use their data to determine correct reorder amounts as cStock links stock reporting to resupply.
cStock is a low cost, system strengthening approach to supply chain that considers all aspects and context when designing and adapting the approach. This approach combines three critical components: simple mobile technology that supports demand-based resupply procedures and connects CHWs to their resupply facility; user-friendly dashboards to allow better visibility, accountability, and transparency; and IMPACT teams to strengthen data use and local problem solving to supply chain challenges.
The initiative's objective is to create an affordable, replicable supply chain tool and implementation model for community health program implementers globally that provides real-time, actionable community health worker supply chain data for supervisors, store managers, and stakeholders to enable demand based resupply, coordinate, plan, and solve supply chain problems to ensure lifesaving commodities are available in communities at all times.
This approach combines three critical components: simple mobile technology that supports demand-based resupply procedures and connects CHWs to their resupply facility; user-friendly dashboards to allow better visibility, accountability, and transparency; and IMPACT teams to strengthen data use and local problem solving to supply chain challenges. The system uses the data reported by CHWs to calculate key supply chain indicators and display them as easy-to-read charts that allow decisions making. The dashboards are available via smartphone or computer. IMPACT Teams provide a structured approach for using data and create a culture of joint problem solving. The IMPACT Teams monitor performance of key supply chain indicators and follow a structured process to identify solutions to challenges with the ultimate goal of improving the performance of their supply chain.
inSupply Health aimed to create a replicable tool (which wasn’t the case with the Malawi cStock app), hence for this Kenyan project, inSupply Health, with the help of the University of Oslo and Kenya’s Ministry of Health, designed a mobile tool that is interoperable with the DHSI2
cStock was piloted in Kenya by over 600 users in 2 sub-counties in Siaya (Bondo and Ugunja) between February 2018 to November 2018. InSupply Health is preparing to roll out cStock to four new counties this year. These counties are in a remote and challenging region in Kenya and with nomadic and migratory populations. As part of the preparation for scale to the new countries JSI is using a human centered design approach to incorporate our findings from the pilot and refine how DHIS2 is configured to improve on the current design using more up to date applications and adapt it for hard to reach nomadic and migratory populations.