Table 2.

Baseline LIAT survey results, all countries

	Countries
Supply chain performance indicator	Malawi (No. CHW = 139)	Rwanda (No.CHW = 321)	Ethiopia (No. CHW = 240)
Product availability at community level (DOV)	• 27% of CHWs had 4 key iCCM products on day of visit (cotrimoxazole, ORS, ACTs 1 × 6 and ACTs 2 × 6) • 35% of CHWs had 3 key iCCM products on day of visit (cotrimoxazole, ORS, and either ACTs 1 × 6 or ACTs 2 × 6)	• 49% of CHWs had 5 key iCCM products on day of visit (amoxicillin, ORS, zinc, Primo Rouge [ACT 1 × 6] and Primo Jaune [ACTs 2 × 6])	• 24% of CHWs had 5 tracer iCCM and FP products in stock on day of visit (ORS, RUTF*, COCs*, DMPA*, and any ACT) (Zinc and cotrimoxazole introduced after baseline)
Product flow	Demand–based resupply but using non–standardized forms and data not consistently used for resupply: • 56% of HC staff determined resupply quantities using a standard formula, though 10% used the same quantity as last month, 5% used knowledge from past experience, 5% used another method, and 23% did not know. Transportation is a constraint for CHWs in collecting products: • 18% of CHWs identified a transport related challenge as their number one challenge with collecting and receiving supplies The problems included “it was too long to reach the resupply point,” “there was no transport available,” “the transport was always broken” and “difficulties carrying supplies.”	Unstructured approach with no defined rules or process to drive resupply: • 62% of HCs resupplied based on (non–standard) documentation; 19% of HCs used a variety of (“other”) methods; 8% of HCs provided the same as last month; 7% and 4% of HCs “didn’t know” or used a formula, respectively	Transitioning to a demand–based system, Integrated Pharmaceutical Logistics System (IPLS), but using fixed–quantity supply (kits): • More than 50% of CHWs reported submitting requests when stock runs low or when they stock out • 66% of CHWs report getting their health products from the HC, 44% report getting from the district health office
Data flow	Despite the existence for SC procedures, visibility of CHW logistics data was poor at higher levels: • 43% of CHWs reported to HCs using a standard form • 55% of HC staff across ten districts (n = 73) reported HSA supply chain data up to district level, and 14% reported this data disaggregated from HC data	Misaligned reporting system, where data flow did not support decision making: • 97% of CHWs received products from HCs, but only 54% of CHWs submitted logistics data to HCs	Due to lack of training and kit system, CHWs were not using the manual IPLS reporting system for iCCM products: • CHWs mentioned 6–7 different reports that they submitted regularly with no single report having more than 30% of HEWs using them. • 14% of CHWs reported using some kind of stock keeping record
Effective people	SC procedures existed, including LMIS forms for CHWs, and CHWs were trained but challenges were identified in supervision and motivation: • 50% reported supervision on SC tasks • When asked about job satisfaction, about 20% of HSAs who manage products ranked a ‘2’ or ‘3’ out of ‘5’	No harmonized procedures for determining resupply quantities for CHWs existed: • CHW motivation to travel and collect products threatened by challenges they mentioned with remuneration (40%), transport (27%) and storage (11%)	Low SC knowledge and skills among CHWs and their HCs: • Only 11% of CHWs and 8% of HC staff had received SC training

ACT – artemisin–based combination therapy, CHW – community health worker, COC – combined oral contraceptive, DMPA – Depo Provera, DOV – day of visit, FP – family planning, HC – health center, HC – health center, HSA – health surveillance assistant, IPLS – Integrated Pharmaceutical Logistics System, LMIS – logistics management information system, ORS = oral rehydration solution, RUTF – ready–to–use therapeutic food, SC – supply chain