Shieshia Mildred, Noel Megan, Andersson Sarah, Felling Barbara, Alva Soumya, Agarwal Smisha, Lefevre Amnesty, Misomali Amos, Chimphanga Boniface, Nsona Humphreys, Chandani Yasmin
JSI Research & Training Institute, Inc., Nairobi, Kenya.
JSI Research & Training Institute, Inc., Arlington, VA, USA.
J Glob Health. 2014 Dec;4(2):020406. doi: 10.7189/jogh.04.020406.
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.
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.
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.
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.
2010年，全球有760万5岁以下儿童死亡，主要原因是可预防的疾病。这些死亡大多发生在撒哈拉以南非洲地区。作为降低儿童死亡率的一项战略，马拉维政府于2008年启动了综合社区病例管理项目，允许健康监测助理（HSAs）在社区治疗患病儿童。然而，马拉维面临卫生基础设施方面的挑战，包括供应链系统薄弱导致产品供应不足。2010年进行的基线评估确定，数据可见性、运输以及健康监测助理的积极性是持续产品供应面临的挑战。该项目设计了一种移动医疗工具，作为应对这些挑战的两项干预措施的一部分。
设计并实施了一种移动健康（mHealth）技术——cStock，用于报告社区库存数据，作为强化管理（EM）和高效产品运输（EPT）干预措施的一个组成部分。我们制定了一个可行性和可接受性框架，以评估干预措施的有效性，并预测其可扩展性和所有权的可能性。分别于2010年5月和2013年2月采用混合方法进行基线评估和随访评估。来自cStock的关于社区库存水平报告的常规监测数据，用于分析干预组18个月期间的供应链绩效。
在强化管理组（n = 393）中，健康监测助理的平均库存报告率为94%，在高效产品运输组（n = 253）中为79%；平均报告完整性分别为85%和65%。在18个月期间，健康监测助理药品再供应的前置时间，强化管理组平均为12.8天，高效产品运输组为26.4天，与高效产品运输组相比，强化管理组6种追踪产品的平均缺货率显著更低。
结果表明，cStock在马拉维对测试用户来说是可行且可接受的，并且基于与高效产品运输组的比较，强化管理组的团队组成与cStock是实现最佳供应链绩效和供应可靠性的必要搭配。建立多层次团队有助于将健康监测助理与卫生系统更高层级的决策者联系起来，使目标一致，明确角色，促进信任与协作，从而推动类似cStock系统的国家自主所有权和可扩展性。
