Improving the Quality and Scale

1. Experiences in Scaling Supply Chain
Interventions for iCCM
Supply Chain Management Subgroup
of the iCCM Task Force
Tuesday 14 April 2015
CORE Group Spring 2015 Global Health
Practitioner Conference

2. Pilot and scaling
cStock and DPATs in
Malawi

3. Pilot to Practice

4. Intervention Design and Refinement
• Kept the design simple and suitable for the context
• Considered sustainability - scalability,
institutionalization and integration – from the design
phase
• Used a systems approach: combined an mHealth
solution with quality improvement structures
• Used quarterly monitoring data to inform intervention
support and refinement of interventions

5. Simple Design
cStock is a RapidSMS, open-source, web-accessible logistics
management information system for community-level health
products in Malawi.
• Uses basic GSM phones already owned by CHWs
to report data via SMS on a toll free phone line
• CHWs in Malawi generally manage 7 or 8 products →
reporting via SMS for all products was feasible and not
burdensome
• Data is cloud hosted
• inexpensive, secure, reliable and easy to manage
option for a small scale system like cStock in a
country like Malawi
• did not require recruiting/training IT support
staff and procuring/maintaining a server

6. Connecting to the Health System
In addition to cStock, District Product Availability Teams (DPATs) were
introduced that use cStock data to monitor and improve SC performance.

7. Stakeholder Consultation
• Engage MOH and partners from the outset
– Project consulted with the MOH and stakeholders when
designing the intervention and throughout the pilot phase.
– Evaluation and monitoring data was shared through meetings
and with individuals.
• Results: Six months after the 6 pilot districts were trained in 2011,
a partner recognized the success of cStock and mobilized
resources to scale up to another 9 districts.

8. – Partnering to Scale builds broader ownership and capacity that
lasts after project ends
• Project and MOH worked with partners to mobilize resources and plan scale
up together
– Results:
• By end of 2014 all 29 districts (3059 HSAs) were trained in cStock and the
DPAT s with funding from WHO, Save the Children, UN Foundation, USAID
and SC4CCM
• Reporting rates to cStock are consistently around 85% (vs. 43% at BL)
Moving from Pilot to Scale
Catalytic Event: Senior MOH Management Team endorsed
scale up of mHealth innovation before midline evaluation
based on positive feedback from users of the system.

9. Starting before the end of pilot (2012) SC4CCM
• Formation of a taskforce (MOH chair) with all stakeholders dedicated to
institutionalization of cStock and DPATs
• Formation of National Product Availability Team to monitor implementation and
provide follow up support to users
• Finding champions in MOH by having central level advocates and trainers in
every districts
• Capacity building of MOH to provide management and leadership, currently
have a secondee in MOH
Transfer of Operational Ownership
• Development of comprehensive, five year
transition plan with cost estimates for
resource mobilization, in the short term, and
eventual transition to MOH budget

10. Lessons Learned
• Design Well
– Consider sustainability - scalability, institutionalization and integration
– from the design phase
– Keep the design simple and suitable for the context
– Use a whole systems approach: combining an mHealth solution with
system strengthening interventions such as quality improvement
processes
• Engage partners and MOH from the outset and consider partnering
for scale up
• Use data to monitor and refine interventions and consult with
stakeholders to get input
• Develop a transition plan well before the end of the project and
help set the ground work for sustainability

11. ore information on cStock visit:
//sc4ccm.jsi.com/cstock/

12. Scaling up iCCM: coordination for
supply chain management
Some complexities in SCM when scaling up iCCM:
 Different programs within the MoH involved
 Different donors for different commodities each with different
funding cycles and reporting
 Many implementing partners
 Different distribution procedures, reporting systems &
supervision mechanisms
 Demand for iCCM may change rapidly during scale up
 Procurement process can take up to 12 months
 Same products used at community level as in facilities

13. Country examples of coordination
Guinea example: coordination for
procurement
• iCCM quantification committee
established
• Forecasting and coordinated supply
plan developed, considering all
orders in the pipeline
• Forecast used by IMCI unit for
mobilizing resources for
procurement
• Supply plan monitored and revised
Rwanda: coordination for
resupply procedures
• Many implementing partners
with different forms & resupply
procedures
• MoH organized a review
workshop- inclusive process
• Harmonized resupply
procedures and forms for use
by all CHWs

14. Key messages
• Communication and coordination between
programs within the MoH, partners and
donors to maximize resources and ensure
supply functions at all levels of the system
• Integrate:
– parallel iCCM programs into the health system
– iCCM supplies into pharmaceutical system
• Need careful planning and a clear strategy for
expansion