title: Quality improvement practices to institutionalize supply chain best practices for iCCM: Evidence from Rwanda and Malawi.
abstract: Supply chain bottlenecks that prevent community health workers (CHWs) from accessing essential medicines significantly increase under-5 child mortality, particularly in poor and rural areas.
  
  
  
  Using implementation research, interventions aimed at improving supply chain practices and access to medicines were tested in Malawi and Rwanda. These interventions included simple demand-based resupply procedures, using mobile technology and traditional methods for communication, and multilevel, performance-driven quality improvement (QI) teams.
  
  
  
  Mixed-method evaluations were conducted at baseline (2010), midline (2013), and endline (2014). Baseline assessments identified common bottlenecks and established performance levels. Midline assessments identified which intervention package had the greatest impact. Endline surveys measured the progress of scale-up and institutionalization of each innovation.
  
  
  
  In both Rwanda and Malawi CHWs, health center staff, and district managers all cited many benefits of the establishment of resupply procedures and QI teams: such as providing structure and processes, a means to analyze and discuss problems and enhance collaboration between staff.
  
  
  
  Implementing simple, streamlined, demand-based resupply procedures formed the basis for informed and regular resupply, and increased the visibility of appropriate and timely community logistics data. QI teams played a critical role in reinforcing resupply procedures and routinely unlocking the bottlenecks that prevent the continuous flow of critical health products. While simple, streamlined, demand-based resupply procedures provide the basis for regular, functional, and efficient resupply of CHWs, the procedures alone are not sufficient to create consistent change in product availability. Supporting these procedures with multilevel QI teams reinforces the correct and consistent use of resupply procedures.
authors: JSI Research & Training Institute, Inc., Ground Floor Acacia Building, Westlands Office Park, Westlands, Nairobi, Kenya. Electronic address: yasmin_chandani@jsi.com.
authors: Yasmin
authors: Y
authors: Chandani
authors: John Snow, Inc. 44 Farnsworth Street, Boston, MA 02210-1211, USA.
authors: Malia
authors: M
authors: Duffy
authors: JSI Research & Training Institute, Inc., 1616 Fort Myer Dr. Arlington, VA 22209, USA.
authors: Barbara
authors: B
authors: Lamphere
authors: JSI Research & Training Institute, Inc., 1616 Fort Myer Dr. Arlington, VA 22209, USA.
authors: Megan
authors: M
authors: Noel
authors: JSI Research & Training Institute, Inc., 1616 Fort Myer Dr. Arlington, VA 22209, USA.
authors: Alexis
authors: A
authors: Heaton
authors: JSI Research & Training Institute, Inc., 1616 Fort Myer Dr. Arlington, VA 22209, USA.
authors: Sarah
authors: S
authors: Andersson
mesh_terms: D002648:Child; D002662:Child Health Services; D003150:Community Health Workers; D018954:Drugs, Essential / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D008295:Malawi; D055553:Prescription Drugs / Q000600:supply & distribution*; D058996:Quality Improvement; D012432:Rwanda
chemical_list: D018954:Drugs, Essential; D055553:Prescription Drugs
keywords: Community health workers; Integrated community case management; Supply chain management