Editorial

We are pleased to issue the third edition of the Ezaka Mendrika bulletin. Ensuring availability of health products to Kaominina Mendrika (KM) salama communities is a top priority for USAID/Santnet2. More than 5,000 trained community health workers (CHWs) need to have continuous access, through reliable sou rces, to key h e alth an d contraceptive products. We have designed a comprehensive and integrated community-level supply chain system. The system relies on both public-sector and social marketing supply chains. To make the new integrated system work, USAID/Santnet2 organized tra in in g sess io n s, d e ve lo p e d monitoring tools, and built required management skills, which allow critical logistical operations to function efficiently at the microlevel. With only 12 months having passed since the new strategy was implemented, 2,560 CHWs have already re-supplied health products at either health facilities or community re-supply points. However, there are still challenges, in particular with respect to social marketing supply chains. Well-deserved praise goes to all who have worked hard to keep health and contraceptive product stock levels consistently higher, making stockouts a thing of the past, and who have steadily improved the overall performance of community supply chains. Have a good reading! Chief of Party (COP)

COMMUNITY-LEVEL HEALTH AND CONTRACEPTIVE PRODUCTS SUPPLY CHAIN CHWs in KM salama communes can be re-supplied with health and contraceptive products through two alternative channels that complement each other one for generic and one for social marketing products. This strategy provides choice to end users and reduces the risk of structural stock-outs. Table 1 below summarizes the routes of both supply chains.

Bulletin Ezaka Mendrika

Level
Central District Commune

Generic products Salama PhaGDis

Social marketing products

Population Services International (PSI) Supply point at the district level

PhaGeCom/Centre de Sant Supply point at the commune level de Base (CSB)

CHW

Community CHW

A 5-day CHW training program includes service delivery topics as well as management themes. CHWs are trained and receive management tools to manage stocks of health and contraceptive products. Table 2 below presents products available to each CHW category and level by supply source. CHW category Generic products

USAID/Santnet2: CHW offering FP services is provided with method van

Social marketing products (SMP)

Cycle beads, Sr,Eau, Pilplan

Mother health 1 Cycle beads, ovrette, condom, CHW Spermicide, Lofemenal

Mother health 2 All level 1 products+ Iron Folic All level 1 products+confiance, CHW Acid (IFA), Depoprovera safety box Child health 1 CHW Child health 2 CHW IFA All level 1 products+ IFA, Cotrim, Zin, Paractamol SrEau All level 1 products+ ViaSUR, RDT ACTipal, safety box, gloves

Volkan Cakir
3rd edition, September 2010 Page 1

USAID/Santnet2 is implemented by RTI International

Over the past 12 months of rapid KM salama scale up, we have recorded impressive successes. In this section, we would like to share a sample of success stories to highlight community-level mobilization in ensuring continuous availability of health and contraceptive products. Andapa: Trainers' association ensures provision of community health workers products. Trainers have joined together in an association called AFACA to prevent stock out of products. They are responsible for supplying products to CHWs in the district. Anjeva Gara: The commune committee (CDS) has voted to finance the commune supply point. The commune committee in Anjeva Gara has agreed to finance setting up its supply point. This commune is one of the KM salama communes supported by the USAID/Santnet2 project. Authorities have agreed to work together to avoid product stock outs in the community.
USAID/Santnet2: CHW workers come toward community level to deliver products

CHW score for selling products:

CHWs performance for distributing products is as follows. Based on 2,560 reports received during April, May, and June 2010, each mother health CHW has sold a monthly average of the following:
5 DPMA injectables, 1spermicide, 1cycle beads, 6 combined oral contraceptives (COC) and 4 IFAs.

KM salama supply chains update:

- USAID/Santnet2 and the social marketing program are organizing workshops on supply systems to reinforce coordination of products supply chains. Workshops will be conducted from August 10 to September 20. One of the main objectives of the workshops is to ensure availability of products to satisfy community needs. - USAID/Santnet2 and PSI will also reinforce the capacity of all supply points at the district and commune level to solve problems related to product availability. The workshops will be conducted in 72 districts where KM salama is implemented. More than 1,000 participants are expected to attend these

For each child health CHW, the average monthly performance is as follows:
60 pills of Cotrim for pneumonia treatment, 60 pills of Zinc for diarrhea, 33 pills of ACT, and 33 pills of Paractamol for fever treatment .
USAID/Santnet2: CHW activity raising awareness about FP services with a mother

Different profiles of supply point managers:

Who are they?
-Supply points at the district level: formal or non-formal local associations (focusing on environment, gender, and rural development), nongovernmental organizations -Supply points at the commune level: physicians, nurses, midwives, members of social USAID/Santnet2: One model of supply point at development committees, shop owners, noncommunity level in Mizilo-Gara Manakara governmental formal and non-formal grassroot Status of community health service supply points for associations (such as womens associations, villagers cooperatives, and youth unions) 800 KM salama communes in 72 districts
(out of 111 total in Madagascar):

Level

Public supply point

Social keting point 100%

marsupply

How are they selected?

The supply points at the community level are selected according to their experience in product management.

District (72 KMsalama 100% district) Commune(800 KM salama 100% communes

What do they do?

They monitor the availability of products to treat diseases of mothers and children under five.

30%

3rd edition, September 2010 Page 2

USAID/Santnet2 is implemented by RTI International