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1. CLICK TO ADD TITLE The 6th Global Health Supply Chain Summit November 18 -20, 2013Addis Ababa, Ethiopia Use of mobile image recognition software and other efforts to improve supply chain management of key health products for community-based distribution in Mozambique Joseph McCord, USAID | DELIVER PROJECT [SPEAKERS NAMES] [DATE]

2. 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)

3. 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 PROJECTTask 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.

4. APE Commodities Essential Medicines Kit Anti-Malarial Kit (30x each of 4 presentations) Rapid diagnostic tests (RDTs) for Malaria

5. Tested interventions were informed by a formal survey IdentifiedChallenges • 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 • 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

6. Logistics data reporting process through ODKscan APE records opening stock, amount received During month, APE fills one bubble for each treatment dispensed APE records treatments dispensed, closing balance, and whether they experienced stockouts At end of month, APE submits completed form

7. 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

8. Logistics data reporting process through ODK scan

9. Results: APEs and their supervisors achieved an average on-time, complete reporting rate of 68% • Results were likely aided by follow up trainings and targeted supervision • No other incentive was provided to APEs

10. 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

11. District supervisors successfully supported the logistics reporting process Photo credit: VillageReach 2013 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

12. 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

13. 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

14. Where to learn more Dell, Nicola, Jessica Crawford, Nathan Breit, TimoteoChaluco, 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.comvillagereach.org ODK: http://www.youtube.com/watch?v=drbdICgJOhI