Getting products to Community Health Workers: The real last mile

Delivering medicine and other commodities to people at locations that convenience them is the most effective approach to improve the health outcomes of over 400 million men, women and children in Africa who live more than 5 km away from the nearest health facility[1]. In the absence of people-centered delivery options, accessing services increases the time and burden of seeking health services, leading to sub-optimal health-seeking behaviors and missed opportunities to provide services. In hard-to-reach communities in sub–Saharan Africa, Community Health Workers (CHW), who are members of the communities where they work, provide a convenient and accessible link to the health system. Supplying CHWs with essential commodities to serve their communities effectively and to protect themselves remains one of the areas that healthcare supply chains need to improve on.

Despite being acknowledged as a viable pathway for attaining universal health coverage in some low-to middle income countries, CHWs are not formally recognized as a cadre in most health systems. They are thus not regarded as healthcare workers who should be routinely supplied with medicine, personal protective equipment and other commodities.

[1] CAF Africa Final Report (Home - CAFAfrica)

What does it take to routinely supply community health workers?

Several factors are consistently identified as being key to getting products to the real last mile, in the hands of a CHW who can take it to a patient’s home. Below are some of the key principles we at VillageReach have learned alongside CHWs and several organizations involved in the advocacy to elevate the status of CHWs in sub-Saharan Africa;

Investing in systems that provide visibility into the community-level commodity demand, location and capacity to supply is crucial: Investments in digital solutions for the collection of transactional data could go a long way to streamlining this flow of information which currently often relies on sub-optimal paper-based systems. To plan for and consistently supply CHWs, we need to know where they are and the type of work they do in order to determine which products they need. The establishment and maintenance of digital records of CHWs that includes their training and location would provide health systems the data needed to include CHWs in supply planning, procurement, or delivery. These “national CHW registries” would help answer the first set of questions. On the other hand, supply chain transactional data collected at the point of service delivery, analyzed and used, in a timely manner, to inform forecasting and demand planning, is cornerstone to determining the quantities needed.

Supply chains are only as good as the people managing them: Supply chain competencies need to be strengthened at the last mile. Supplying CHWs with commodities requires skilled staff who can estimate their commodity requirements, manage inventory from the source, through the supply chain, and deliver it to a wide network of pick-up locations. Historically, people with these skills were targeted on at the central, regional levels of the health system as well as within health facilities. A shift in the allocation of suitably qualified and dedicated supply chain specialists is needed to include supply chain focused personnel to cater for the commodities provided to CHWs and communities served by them.

Transport networks need to be optimized to improve community service delivery: CHWs add new and non-traditional locations i.e. extending beyond the traditional health facilities on supply chain design. Integrating CHW services into health systems involves reconfiguring supply chain networks to include these new service delivery points. Opportunities to achieve cost effective processes can be achieved by collaborating to integrate transportation of commodities for CHW delivery points with private (or other) sector entities that have spare distribution capacity to service delivery points; incorporating the use of lower cost transport options e.g. motorbikes suitable for carrying the smaller volumes to CHWs; leveraging ride sharing platforms i.e. “Uber-like” services focused on commodity movement. These are just some of several options that exist to deliver supplies to new locations e.g. community halls, churches, grocery stores that could serve as more convenient collection points for CHWs.

More evidence needs to be generated to prove that CHW supply chains provide a sustainable and cost-effective means of delivering health products to under-served populations. They also could present viable commercial opportunities. This would, in turn, provide a basis for allocation of budgets and investments from governments and the private sector respectively to scale systems for supplying CHWs.

Significant strides have been made in countries like India, Liberia, Ethiopia and others in optimizing supply chains to serve, train them and equip CHWs. More can be done by supply chain professionals to design systems that meet the needs of the men, women and children whose lives CHWs touch every day.

Disclaimer: this article was written by external expert contributors to CEVA Insights. The perspectives and ideas are the contributor's and do not necessarily reflect the views of CEVA Logistics.