Newsroom & Blog

Sep 28, 2023   |   Blog Post

Together We Rise: The Power of Collaboration to Transform Health Care Delivery in Liberia

CHAs learning to use solar panels to recharge the application due to a lack of electricity (Photo credit: Aaron Aggrey)

By Christine Lenihan

Senior Manager, Digital Solutions

“Coming together is a beginning, keeping together is progress, working together is success.” Edward Synge-Morley

Radical collaboration is at the heart of VillageReach’s work. Over its two-decade history, VillageReach has collaborated with governments, the private sector and civil society organizations to develop, implement and scale solutions that support equitable access to quality health care delivery for all.

Demonstrating this collaborative ethos is our work to strengthen Liberia’s community health worker (CHW) supply chain. The goal of this work is to reduce health commodity stockouts amongst CHWs, so they are supplied and empowered to provide primary health services in their communities. As part of our Supply Chain for Community Health Workers (SC4CHWs) solution, VillageReach partnered with the Liberian Ministry of Health (MoH), Last Mile Health (LMH) and Ona to develop an electronic community-based information system (eCBIS) with integrated supply chain data collection and inventory management features.

The eCBIS supply chain module was designed to address the supply chain challenges faced at the community level in Liberia, such as lack of data for decision-making, limited supply chain expertise and inconsistent delivery systems. These challenges often resulted in life-saving drugs and vaccines being unavailable.

It hasn’t always been a smooth journey. Radical collaboration means reevaluating and shifting priorities, adjusting our work plans and timelines, and making compromises.

So, is the collaborative effort worth the potential challenges? Our unequivocal answer is yes! Despite challenges, the positive impact of such endeavors is undeniable—as witnessed in the eCBIS project in Liberia.

Our collaborative effort began in 2019 when VillageReach and LMH partnered to improve community health supply chains. CHWs have proven impact and effectiveness in improving health outcomes for the communities they serve. Their impact, however, is often limited by stockouts of essential medicines and supplies, reducing productivity and motivation.

Globally, CHWs are stocked out of essential medicines one-third of the time. To address this challenge the SC4CHW initiative combined VillageReach’s supply chain experience with LMH’s experience with CHWs – called community health assistants or CHAs in Liberia. Together, we recognized that working together on this issue can have a far greater impact than working alone.

Electronic Community-Based Information System (eCBIS) training (Photo credit: Aaron Aggrey)

When exploring the possibility of building a digital tool to support the CHA supply chain, we discovered that LMH was also planning a similar digital initiative. Rather than creating a separate, siloed application for the supply chain, requiring CHAs to use two applications to complete their work, we expanded our partnership. VillageReach supported the development of a supply chain module within the eCBIS, while LMH and MoH developed the eCBIS on the Open Smart Register Platform (OpenSRP). Ona, the development team behind OpenSRP, was integrated into our alliance. That meant that from the start, we had two implementing partners and a technology partner working with the government to develop a single application.

In addition to the more “formal” partnership between the MoH, LMH, VillageReach, and Ona, there were several other key stakeholders whose collaboration was vital for developing the digital solution. There were other National Community Health Assistant Program (NCHAP) implementing partners like LMH that worked with other Liberian counties, the county health teams, and, of course, the CHAs and their community health services supervisors (CHSS) who would be the actual end-users of the application. Without effective collaboration, eCBIS could have been relegated to the fate of many digital health tools: celebrated in pilot stages but seldom scaled or sustained.

Screenshot of the eCBIS application

We certainly faced challenges due to the complex partner and stakeholder collaboration. But at the same time, our partnerships helped us overcome these challenges and improve our solution. For instance:

Challenge: Partner plans to develop a competing application
Result: Close collaboration with the MoH ensured government buy-in, ownership of the eCBIS, and desire to have a CHA solution that could be scaled nationally rather than separate, duplicative systems. With support from VillageReach and LMH, the MoH convened a technical working group, including other implementing partners, so they could provide input on eCBIS development.

Challenge: Process variations across counties.
Result: VillageReach, LMH and the MoH coordinated with partners to conduct beta-testing in both LMH-supported and non-LMH-supported counties in the pilot. This ensured that CHAs from multiple counties provided feedback to improve the eCBIS and that the application supports CHAs across the country regardless of the implementing partner.

Challenge: Dependence on external elements for application development.
Result: We partnered closely with LMH, Ona and the MoH to maintain an integrated approach and identify dependencies and potential risks. Even if it meant tweaking our timelines, our collaboration allowed us to jointly develop, test, and pilot the eCBIS in a unified manner.

Development of a user-friendly application

User-centered design principles and collaboration with CHAs/CHSS enabled the development of a streamlined, user-friendly application: 97% of CHAs across four counties reported that they strongly agreed or agreed with the statements “I think eCBIS is easy to use” and “I would like to use eCBIS all of the time” in the beta-testing assessment.

Collaborating with other implementing partners for development input and beta-testing ensures that the eCBIS fits their requirements so it will be ready to scale beyond the pilot counties, and there are no duplicative systems that would need to be reconciled.

Due to our partnerships and collaboration, there is strong buy-in and ownership from the MoH. They were actively involved in application testing, pilot planning, and providing approvals. We are now working with the MoH to ensure sufficient capacity to support and maintain all aspects of the system, from hosting to training, to ensure the system can be transitioned and sustained in the future.

Working in radical collaboration can be messy and complex, but it is essential to building effective solutions that can be easily adopted, scaled, and sustained. As we conclude the eCBIS pilot training, we are confident in the eCBIS solution and its potential to strengthen community health supply chains and support strong PHC delivery in Liberia for years to come.

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