Community health workers are fundamental to health care access in Liberia, bridging the gap between communities – especially hard-to-reach populations – and public health systems. Despite their significant role, community health workers, or community health assistants (CHAs) as they’re known in Liberia, do not have consistent access to the full-range of health products they need to provide appropriate care at the community level[1].
In 2010, the Liberia Ministry of Health (MoH) created the 10-year Supply Chain Master Plan (SCMP) – a roadmap to improve health commodity supply chains across the country and reduce stockouts for CHAs. The pace of implementation was sluggish and coordination became a challenge. To address the coordination challenges, the MoH institutionalized the Supply Chain Technical Working Group (SCTWG) to serve as a forum for formulating evidence-informed recommendations for policies, provide high-level technical and strategic expertise to MoH departments and programs and facilitate dialogue and alignment of activities among stakeholders.
My first experience with the SCTWG was in 2016, when I worked for Management Sciences for Health (MSH) as a supply chain mentor for the Lofa County Health Team. One of my key responsibilities was to establish monthly SCTWG meetings. Regular and consistent meetings are important, as they serve as opportunities to identify emerging supply chain challenges – such as stockouts – and determine opportunities for improvement. I took this experience to the Grand Basa County Health team, where my collaborators and I established a high-functioning SCTWG.
In my current role as a supply chain specialist for VillageReach, I provide technical assistance to the Margibi County Health Team’s SCMU. Since 2019, VillageReach has worked with the MoH and Last Mile Health to connect CHAs to the country’s public health supply chain. As a part of this work to improve commodity availability and deliver more products to people, VillageReach aims to leverage the organization’s strengths in supply chain management to enhance the capabilities of county SCMUs.
When I arrived in my new role, the county SCMU was struggling to adopt the SCTWG’s mandate. At the time, SCTWG meetings were held on an ad hoc basis with meetings occurring once every four to six months with no shared meeting minutes or action points.
Building a working group that delivers
The supply chain specialist chairs the Marigibi County SCTWG in Liberia. Photo credit: Nathan Tartee and Andrew Snorton.
We made several changes to improve and strengthen the Margibi County Health Team SCTWG so that we can yield the impact I had seen in other counties to address supply chain challenges.
- We held regular meetings: From March to September 2022, we held five meetings. These meetings brought together stakeholders to regularly discuss the supply chain achievements and challenges, finding solutions to address some of the challenges that had been outstanding for the past few years. Some of these challenges included infrequent submissions of logistics management information systems (LMIS) reports – which track health commodity availability at health centers – from county data officers and health facilities, reverse logistics, staff attrition, inadequate storerooms and stockouts. We also improved support for supervision visits to health facilities and for the collection of LMIS data.
- We tracked action points and shared meeting minutes: All action points can now easily be retrieved for referencing, and the meeting minutes can be shared with participants and relevant stakeholders at the MoH about Margibi County Health Team supply chain activities. They are now shared weekly over email. This promotes meeting transparency and ensures we are staying on track with program deliverables.
- We present a Quarterly LMIS Report on data quality analysis: Through the data quality analysis report, program supervisors, partners and others at the SCTWG meeting are now aware of facilities that are submitting the report on time, the completeness of their reports and facilities that are not reporting on commodities for individual follow-up during supervision visits.
Maintaining group resiliency to support future growth
With a SCTWG that meets regularly, documents its actions and key deliverables, we can strengthen the public health supply chain in Liberia, which in turn can lead to 1) increased security of health commodities, 2) strong implementation of all components of Supply Chain Management (SCM) and 3) solid coordination, sharing of ideas and documented trail of action points that will support future decisions. We do this by:
- Sharing information and updates to stakeholders on health commodity stockout status, including which facilities have more of a certain item, such as vaccines, and which ones are lacking certain products;
- Managing the overall security for health commodities and leading the implementation of all components of SCM, which includes product selection, forecasting and quantification, procurement, warehousing and distribution, and LMIS, monitoring and supervision;
- Developing solutions for common supply bottlenecks or challenges;
- Ensuring that key stakeholders are aware of their responsibilities in the implementation of the Supply Chain Master Plan.
[1] Olaniran, A., Briggs, J., Pradhan, A. et al. Stock-outs of essential medicines among community health workers (CHWs) in low- and middle-income countries (LMICs): a systematic literature review of the extent, reasons, and consequences. Hum Resour Health 20, 58 (2022). https://doi.org/10.1186/s12960-022-00755-8