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Getting Meds to Sick Kids at the End of the Supply Chain

For community case management to be truly effective, countries and partners must invest in supply chains so that they can forecast, finance, procure, and deliver life-saving medicines to community health workers.
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Imagine you are a mother living in a remote village and have to walk for hours carrying your sick baby or toddler every time your child needed care. Would you go at the slightest sign of a cold or fever, or would you wait and hope for the best? Would you recognize the point at which waiting further would be dangerous? What if you didn't have enough money to pay for the services at the health clinic 10 kilometers down the dusty trail, and going meant time away from the work you do to help feed your family? Worse still, what if when you got there, the clinic didn't even have the needed medicines? These are some of the reasons caregivers delay or never seek care for their sick children and why every year 6.9 million children die of largely preventable diseases before they reach their 5th birthday. And these are the reasons why important work is being done to train and equip health workers in local communities to treat the most common causes of preventable child death.

As we recognize World Pneumonia Day on November 12, we are reminded of the deadly impact pneumonia has on families around the world. Pneumonia is the leading killer of children under age 5. In 2011, 1.2 million children under five died from pneumonia -- more than the number claimed each year by AIDS, malaria, and tuberculosis combined. Pneumonia affects children around the globe, but it is particularly devastating in sub-Saharan Africa and South Asia.

In an approach that is gaining recognition, many countries now train and equip community health workers (CHWs) with the skills and medicines needed to bring care closer to children, through community case management. Today, low-cost pneumonia treatment is available as child-friendly amoxicillin tablets that quickly and easily dissolve in a small amount of water.

However, ensuring that community health workers always have enough of the right medicines to treat sick children is critical. Every time a child with pneumonia is diagnosed correctly and treated with the appropriate antibiotic dose in time, a life can be saved. Multiply this across thousands of villages and communities, and several countries and the impact can be seen globally.

One of the greatest challenges facing community health workers is that they cannot count on supply chains to provide a reliable supply of essential medicines. There are several components to the problem. First, many countries rarely have enough funding to buy all the medicines they need. Since CHWs are at the last mile of the supply chain, they often face the most acute shortages and are the last to receive products. Low product funding level is further exacerbated by weak and fragmented public health supply chains, which suffer from inadequate leadership and years of under investment. Transportation infrastructure is weak, and geography and difficult climates may render large areas unreachable for several months a year. Finally, procurements are often delayed by bureaucracy, do not benefit from competitive prices, and sometimes result in suboptimal products being purchased. There is good news, though. When made a priority, supply chain performance can and has drastically improved.

For community case management to be truly effective, countries and partners must invest in supply chains so that they can forecast, finance, procure, and deliver life-saving medicines to community health workers. Furthermore, the community supply chain should be designed with CHW needs in mind rather than merely an ad-hoc addition to an existing system. Community health workers not only need to be equipped with skills and products to treat patients, but also able to conduct the key supply chain tasks to ensure that product shortages are minimized.

The recently-launched UN Commission on Life-Saving Commodities for Women and Children provides a unique platform to catalyze progress on this otherwise forgotten killer. It is an opportunity to raise the profile of pneumonia and awareness of available prevention and treatment methods, so that what many believe to be a common but non-fatal household illness is recognized as the global scourge to childhood that it is. This will require not just a commitment to case management for pneumonia at the community level, nor even a commitment to procure the products, but to support and strengthen the systems to ensure that the medicines reach the very lowest level of the supply chain and are available from all trained community health workers, whenever a sick child needs them.

Joel H. Lamstein
President, John Snow, Inc.

JSI Implements the Supply Chain for Community Case Management initiative funded by the Bill & Melinda Gates Foundation in Ethiopia, Malawi, and Rwanda.

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