When people cannot access health products, we must prioritize delivering those products directly to them.
For decades, health care systems have focused on health facilities and hospitals as the primary points of care. However, this approach leaves behind under-reached communities (both rural and urban). In Africa, there are a myriad of reasons that communities cannot reach a hospital or health facility (i.e., geographic, financial and cultural barriers), all of which contribute to only half the continent having regular access to health products and services. We will never tackle inequitable access to medicines and vaccines with traditional clinic-centered supply chain approaches.
We need bold innovation and a shift to people-centered approaches that extend supply chains through more accessible service delivery points, including home-based services.
A Paradigm Shift
“Supply Chain Beyond the Clinic” panel at the Global Health Supply Chain Summit 2024 (Photo Credit: Ronald Ng’eno)
Last year, I had the opportunity to participate in a panel discussion titled ‘Supply Chain Beyond the Clinic’ at the Global Health Supply Chain Summit. During the conversation, my peers from Reach52, Last Mile Health, Africa Resource Centre and I acknowledged the cost and complexity of delivering health products to the last mile. But we also emphasized that shifting to a people-centered supply chain approach is the only real way to achieve universal health care.
The truth is that without access to essential medicines, treatable conditions worsen, leading to preventable death and disease. For example, early treatment of malaria at the community level is far more cost-effective than addressing complications that require hospitalization and intravenous therapies.
However, concerns about the rational use and storage of medicines at the community level complicate efforts to make supply chains more people-centered. This false generalization about the irrational use and poor storage of medicines in community-based health service delivery is rooted in bias. When it is assumed that only ’certain professionals’ or ‘institutions’ can effectively manage medication, it overlooks the crucial role of community health workers (CHWs) in low- and middle-income countries and threatens the effectiveness of community-based health initiatives.
We need to shift our focus from the reasons we cannot get medicines closer to people’s homes and begin thinking more expansively. It’s time to embrace bold ideas, take calculated risks and foster innovation. Embracing people-centered supply chains is all about building more responsive primary health care systems. Such systems prioritize the delivery of health products and services in ways that meet the unique needs of patients while ensuring sustainability.
Here are three actionable strategies for governments and their partners to get health products from clinics to communities.
1. Professionalize Community Health Workers
CHWs are a critical link between health systems and communities, especially in rural areas. However, their potential is often limited by stockouts, inadequate training and policy barriers. Integrating CHWs into national supply chains can change this dynamic. For example, Liberia’s integration of CHW supply chains into its National Supply Chain Master Plan has standardized processes and improved medicine availability for CHWs.
Tools like the electronic Community-Based Information System (eCBIS) enhance CHWs’ ability to manage supplies and deliver care. In Kenya, targeted CHW training on supply chain management has been incorporated into the national curriculum, scaling a successful pilot project to a nationwide initiative. These efforts demonstrate how tailored solutions can equip CHWs with the resources and skills needed to serve their communities, improving both access to and quality of the health services they provide.
2. Engage the Private Sector
The private sector plays an increasingly vital role in strengthening health supply chains. Social enterprises like Reach52 are pioneering innovative approaches to extend access to health products. Governments can bridge gaps by harnessing private sector agility and efficiency in service delivery. For example, logistics outsourcing for transport or warehousing has proven effective, and opportunities continue to grow for governments to collaborate with local private pharmaceutical distributors and supply chain innovators.
3. Foster Radical Collaboration
No one stakeholder can build people-centered supply chains, and there will never be a one-size-fits-all solution. Thus, strengthening community supply chains demands high levels of collaboration. For example, the private sector alone cannot replace the government’s role in providing safety nets for the most vulnerable populations. Research has shown that even minimal user fees can create barriers to access for low-income households. Therefore, governments, private sector, donors, technical partners and communities must align their efforts toward common goals. At VillageReach, for example, partnerships with the Kenya Ministry of Health and the Community Health Units for Universal Health Coverage (CHU4UHC) platform and co-designed tools like eCHIS, have demonstrated how shared accountability and user-friendly solutions can drive impactful results.
Reaching Everyone
Supply chains that extend their reach beyond health facilities represent a new era of health care delivery that focuses on ensuring products and services are available where people are – not where we think they should be. Building people-centered supply chains aligns services with community needs, improves health outcomes and promotes equity for marginalized populations. The road ahead requires investment in innovation, advocacy for community supply chains and radical collaboration. However, while the journey may be challenging, the destination—health care for all—is worth every effort.