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. 2012 Nov;87(5 Suppl):120-126.
doi: 10.4269/ajtmh.2012.11-0781.

Factors affecting availability of essential medicines among community health workers in Ethiopia, Malawi, and Rwanda: solving the last mile puzzle

Yasmin Chandani, Megan Noel, Amanda Pomeroy, Sarah Andersson, Michelle K Pahl, Timothy Williams

Factors affecting availability of essential medicines among community health workers in Ethiopia, Malawi, and Rwanda: solving the last mile puzzle

Yasmin Chandani et al. Am J Trop Med Hyg. 2012 Nov.

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.

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Figures

Figure 1.
Figure 1.
The five preconditions of product availability in the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project. CCM = community case management; CHW = community health worker.
Figure 2.
Figure 2.
Availability of oral hydration solution (ORS) and Coartem (artemether/lumefantrine) (AL) at resupply points (Res) and community health worker (CHW) service points in Ethiopia, Malawi, and Rwanda.
See this image and copyright information in PMC

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