Use of mobile image recognition software and

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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