In Liberia, Community Health Workers (CHWs) are often the only link to primary health care services for the most under-reached communities. To support them, the Liberia Ministry of Health, Last Mile Health and VillageReach are working together to make sure they have access to essential medicines for their communities. This photo essay is the first half in a two-part series showing how supplies arrive to CHWs, or Community Health Assistants as they are known in Liberia, in three counties that benefit from the Supply Chain for Community Health Workers program.
Read on to see where the distribution process begins for Rivercess County and what happens when health supplies arrive at a local facility.
*All photos in this story were taken before the COVID-19 pandemic arrived in Liberia.*
Packing supplies at the Rivercess County Drugs Depot
Picking and packing products at the county depot is the first step in getting supplies to the last mile. This involves identifying the commodities, removing them from inventory and packing them according to the individual facility needs, and then preparing them for safe transport. This process usually takes five days to complete.
Loading supplies for distribution
In three counties, Last Mile Health procures the health products for distribution to facilities, specifically for CHWs use. There is a monthly restock of these commodities to health facilities that Last Mile Health, VillageReach and the County Health Team help to jointly deliver. This includes supplies for the CHWs deployed through the National Community Health Assistant Program (NCHAP), which aims to ensure every rural and remote community in the country is served by a professionalized CHW. VillageReach provides supply chain logistics expertise to ensure CHWs are included in planning, while Last Mile Health provides technical support and collaborates with County Health Teams and the Ministry of Health to train and deploy paid, professionalized CHWs.
Getting supplies to the health facilities
Rivercess County has the largest number of rivers and bridges of any county in Liberia. Some bridges are passable throughout the year while others are not safe during the rainy season. The delivery team has to stop each time they come to a bridge to assess its durability. There are times when the health facility staff must meet the distribution team at the bridge to help deliver the supplies if the bridge is not passable. If a facility is close, the team can walk on foot, or they rent a motorbike to deliver the supplies.
In some cases, canoes are used to cross waterways. For instance, when the Supply Chain for Community Health Workers program kicked off in 2019, the team travelled to Rivercess County to discuss the technical assistance that VillageReach would provide to County Health Teams. But the Timbo Bridge connecting Grand Bassa and Rivercess Counties was broken, so the only means to get across was by canoe. This also happens in other counties, so whether by truck, on bike, in canoes or on foot, there can be many modes of transportation to deliver supplies.
To reach the six health facilities in the Morweh District of Rivercess County, delivery trucks have to travel by muddy roads that become extremely challenging to navigate during the rainy season. The team can spend many hours, or even a night, waiting for the road to become accessible.
Receiving supplies at the health facility
Before the medicines and supplies can even be delivered to the health facility, an inventory of the Community Health Services Supervisor’s stock is taken and they request what they need based on the average number of CHWs and their monthly use of medicines as well as any additional buffer room.
When the products reach the health facility, the Officer in Charge and the supervisor review the delivery, while the Drugs Depot Focal Person unpacks them to verify against the delivery note.
Storing medicines properly and planning delivery to Community Health Workers
New inventory is stored in the medicine storeroom. Each commodity has a stock card for tracking, and the storekeeper is responsible for updating the information to complete the receiving process.
Properly arranging the shelves is important to ensure product visibility and reduce waste due to expiration. Initially, health facilities did not arrange their commodities in their storeroom. Now, with aggregated arrangement, it is easy for supervisors to complete quarterly reports timely and accurately. On a monthly basis, Last Mile Health and VillageReach supply chain specialists provide mentorship support to supervisors, officers-in-charge, storekeepers and dispensers on storage best practices.
Supervisors must update their commodities’ stock cards before commencing routine supervision visits to CHWs.
Logistics management training and mentorship visits have improved the tracking of 16 essential medicines and supplies that CHWs need to deliver routine primary health services. This has decreased the risk of stock-outs and provides more accurate information for quarterly resupply planning.
Now that you’ve seen a closer glimpse of the challenges faced during distributions and the storage process, stay tuned for our next segment to learn how we equip CHWs with health products for their communities.
Read part two here.