Tools for community health workers to ensure availability of medicines for maternal and child health

 {Photo credit: Sheila Mwebaze/MSH}Community health worker Betty Achilla examines a baby at one of the 31 households she supports.Photo credit: Sheila Mwebaze/MSH

Eight years ago, Betty Achilla was selected by her community to be a volunteer community health worker. She is currently serving 31 households in the Abim district in Northeastern Uganda. Betty is one of more than 60,000 volunteer community health workers in Uganda who play a vital role in extending maternal and child health services to hard-to-reach communities.

As a community health worker, Betty was trained in the basics of diagnosing and dispensing medicines to treat common childhood illnesses such as malaria, diarrhea, and pneumonia and to identify danger signs in children and refer them to nearby health centers. To do her work, Betty must have an adequate and consistent supply of malaria rapid diagnostic tests, antimalarial medicines, oral rehydration solution, zinc, and antibiotics.

In 2016, a national assessment showed that stock-outs were frequent and a common cause of service disruption in community health programs. No national guidelines existed, and no coordinated national planning and monitoring of community-level commodities was in place. Programs and partners used their own approaches to training, supervising, delivering, managing, and reporting on community health commodities.

Based on the assessment findings, the USAID-funded Uganda Health Supply Chain program worked with the Ministry of Health and other partners to streamline and strengthen the management of and accountability for medicines and health supplies in community health programs.

Standardized supply chain training materials, procedures, and tools were developed for use across all community health programs. These tools—a consumption log, magic calculator, dispensed and stock balances, request summary, and product issue log—ensure that community health workers routinely capture the information needed to plan, quantify, order, deliver, and track supplies.

Prior to national rollout, a one-year pilot test of the tools and training materials was conducted from May 2017 to June 2018 by the Ministry of Health and several partners involved in community-based family planning and integrated community case management programs in Abim, Kayunga, Kiruhura, Mubende, and Ntoroko districts. The pilot involved 539 community health workers, 52 health facility staff, 28 district health teams, and 18 national trainers. Community health workers were trained to use the tools and improve their skills in ordering, tracking, and storing medicines:

“Using the consumption log, I can now track medicines for reporting. My work has been made easy and I know the quantities of medicines in my medicines box,” said Betty.

[Rebecca Kabugho, Nursing Officer at Karugutu Health Center, trains Village Health Teams (VHTs) on how to use the medicines consumption log. Photo credit MSH]Rebecca Kabugho, Nursing Officer at Karugutu Health Center, trains Village Health Teams (VHTs) on how to use the medicines consumption log. Photo credit MSH

 The new tools have also made the job of health officials easier:

 “Before introducing the tools, there were no clear ways of tracking consumption of community level medicines. We can now track medicine consumption and disease patterns,” said Dr. Anthony Okengo, the District Health Officer. “The tools are helping in planning how much supplies to give to the community health workers, which will improve availability of medicines and ensure a healthy and happier community.”

The results of the pilot program showed that most community health workers, many with low education levels, can correctly complete the consumption log (82%) and regularly carry out good management practices such as monthly physical counts of medicines (75%). The tools provide information required to make evidence-based decisions at the facility, district, and national levels to ensure continuous availability of medicines to meet client needs. This has contributed to commodity security for maternal and child health commodities in the community.

[Barbara Kabagenyi, Nurse at Karugutu Health Center trains parish coordinators in Bweramule on how to use the magic calculator. Photo credit: MSH]Barbara Kabagenyi, Nurse at Karugutu Health Center trains parish coordinators in Bweramule on how to use the magic calculator. Photo credit: MSH

Based on the findings of the pilot, the Ministry of Health scaled up the use of the tools and procedures across the country. Community health workers in two districts supported by Save the Children were trained and are currently using the standardized tools. In 2019, UNICEF, the Global Fund, the Malaria Consortium, the USAID/UK AID-funded Malaria Action Program for Districts, PATH, FHI 360, and others used the tools to reach 52 of the 70 districts that implement integrated community case management, reaching about 50,000 community health workers.

The community supply chain tools have been used in different contexts beyond just community case management, including a community-based family planning program that uses drug shops as access points for community health workers to resupply injectable contraceptives. The Ministry of Health used the tools to distribute and monitor personal protective equipment beyond the health facility during the 2019 Ebola epidemic response in Kasese district. The usability of these tools and training in different contexts has made their scale up sustainable.