Preventing Drug Shortages With Cell Phones in Malawi

Eighty percent of the 13 million Malawians live in rural areas, making delivering health services challenging, especially in remote parts with no roads. Photo courtesy of JSI/cStock.

BALAKA, Malawi — Saidi Masemba’s clinic is a small, two-room mud hut in central Malawi that serves approximately 3,000 local residents. He sees roughly 15-20 patients per day, usually children under 5 years old suffering from malnutrition, malaria, dehydration and diarrhea. In treating these preventable diseases, one of Masemba’s biggest setbacks is access to medication and supplies.

Often, he has to turn patients away or encourage them to come back at a later time to receive their necessary medication. This scenario is common in rural clinics, where supplies and medications are scarce, causing what is known as a “stock out.”

Health Surveillance Assistants (HSAs) receive training on the cStock system.

That’s why the Malawi Ministry of Health (MOH), in partnership with public health research organizations such as John Snow, Inc. (JSI), has developed a mobile health program called cStock. It’s part of a larger project with the goal of finding affordable, simple and sustainable supply chain solutions that address the unique challenges of community health workers.

cStock is a mobile text message-based reporting and web-based resupply system currently being used by more than 1,000 community health workers — commonly known as health surveillance assistants (HSAs) — for monitoring and managing community-level essential medicines and commodities for child health, family planning and HIV testing. In a 2010 Ministry of Health assessment, only 27 percent of HSAs had all the medicines they needed to treat pneumonia, diarrhea and malaria in stock on the day officials visited. HSAs live in the villages and are available day and night for patients to bring sick children to be treated quickly.

The mobile system allows HSAs to transmit information regarding their supply of 19 essential medicines to their local health center. The system is called cStock because it literally allows district and central level staff to “see” what medications and supplies are in stock at the community level. This transparency streamlines the needs of HSAs to their local health center, hopefully preventing future “stock outs” and improving relevant supply chains.

By using mobile technology, health care workers such as Katanga are able to text their medication and supply needs to health centers on a bi-weekly schedule. “I used to turn patients away because I didn’t have the proper medication to treat even the simplest case of diarrhea,” Katanga said while visiting his small clinic. “Now that I’ve been trained to use cStock, I am hopeful that I won’t have to turn away the children and I can better serve my community.”

cStock is part of The Supply Chains for Community Case Management Project (SC4CCM), which is a five-year project aimed at identifying, testing and implementing interventions in supply chain management in three countries: Malawi, Rwanda and Ethiopia. SC4CCM has also trained more than 45 data collectors to use Java-enabled mobile phones equipped with data collection software to conduct assessments of community case management supply chains.

While cStock is improving access to medication and supplies on the rural and health center level, there are still challenges. Clinics are understaffed and overcrowded and electricity is not reliable, making it difficult for community health workers to have a steady and consistent charge on their phones.

But officials say these challenges are being addressed at the Ministry of Health level as qualified health workers are being trained and electrical infrastructure is a priority nationwide.

Masemba, for one, is grateful for his training, particularly given that one of his recent patients was his own son. “I ran out of rehydration salts last week but was able to get a new batch of medication yesterday,” he said.

This story is part of a series of reports on the impact of mobile technology and health in 10 African countries. For more, visit The Cheers Report.