PILOTING CSTOCK Submitted to: Siaya Community Health Department National Ministry of Health IN SIAYA COUNTY: ENDLINE Submitted by: EVALUTION JSI Research & Training Institute, Inc. inSupply Health Ground floor, Acacia Building REPORT Westlands Office Park Westlands, Nairobi, Kenya Telephone: +254 739 393 844 November 2018 Support for this work was provided by Saving Lives at Birth partners: the United States Agency for International Development (USAID), the Norwegian Agency for Development Cooperation (Norad), the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.K. Department for International Development (DFID), and the Korea International Cooperation Agency (KOICA) and JSI Research & Training Institute, Inc. (JSI) shall have the right to duplicate, use, or disclose the data to the extent provided in the grant. This restriction does not limit Saving Lives at Birth partners’ right to use information contained in these data if it is obtained from another source without restriction. JSI Research & Training Institute, Inc. JSI Research & Training Institute,1616 Inc North (JSI) Fort Myer Drive 703 528 7474 Voice Arlington Virginia 703 528 7480 Fax 22209 USA [email protected] Email www.jsi.com Web JSI Research & Training Institute, Inc (JSI) is a U.S.-based health care consulting firm committed to improving the health of individuals and communities worldwide. Our multidisciplinary staff works in partnership with host-country experts, organizations, and governments to make quality, accessible health care a reality for children, women, and men around the world. JSI’s headquarters are in Boston, Massachusetts, with U.S. offices in Washington, D.C.; Atlanta, Georgia; Burlington, Vermont; Concord, New Hampshire; Denver, Colorado; Providence, Rhode Island; and San Francisco, California. JSI also maintains offices in more than 40 countries throughout the developing world. InSupply Health is an independent supply chain advisory firm, affiliated with JSI Research & Training Institute, Inc., based in East Africa that provides our clients with customized guidance on supply chain management and design. inSupply health is increasing data visibility and the use of data to drive strategic and operational supply chain decision-making, demonstrating the feasibility of innovative solutions for the last mile, and strengthening local and regional supply chain capacity. The Replicating cStock: “Making Essential Health Commodities Available at the Community Level project” was made possible through the generous support of the “Saving Lives at Birth” partners; The United States Agency for International Development (USAID), the Norwegian Agency for Development Cooperation (NORAD), the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.K. Department for International Development (DFID), and the Korea International Cooperation Agency (KOICA). The project aimed at assessing whether implementing the cStock approach using mobile technology, user-friendly dashboards, and Information Mobilized for Performance Analysis and Continuous Transformation (IMPACT) teams leads to better availability of critical Integrated Community Case Management (iCCM) commodities in community-based health programs in Bondo and Ugunja Sub-Counties, Siaya County, Kenya. This End line report has been prepared by JSI and does not necessarily reflect the views of the Saving Lives at Birth partners. 1 JSI Research & Training Institute, Inc (JSI) ACKNOWLEDGMENTS Over two years of the cStock pilot project, remarkable achievements have been made in Siaya county towards strengthening the community health supply chain in order to ensure availability of adequate health commodities to the community health volunteers (CHVs). In particular, the cStock Project would like to acknowledge the hard work and commitment of the Siaya County Ministry of Health who supported the work from the onset and built a collaborative and cohesive environment among stakeholders to work towards one common goal. Further, the National Ministry of Health through the Community Health and Development Unit (CHDU) offered guidance and support to the cStock project throughout its implementation. All MOH staff from the national, county, Sub County, health facility and community levels played a key role in supporting the implementation of the cStock project and improving the community health supply chain management system. The project would also like to acknowledge University of Oslo and Aurasafira Kenya who dedicated their time and effort in the design of the cStock platform. We would like to express our appreciation to the many people and organizations that worked on and contributed to the baseline, Mid-line and End line assessment: Gilbert Aluoch who lead and supervised the baseline, midterm and end line assessment The Siaya team (county/sub county health management teams), Community Health Assistants (CHAs) and CHVs for their cooperation and partnership during the project implementation and the assessments. We would also like to thank all the individuals who participated in the surveys and qualitative interviews. 2 JSI Research & Training Institute, Inc (JSI) TABLE OF CONTENTS Acknowledgments........................................................................................................................... 2 Table of Contents ............................................................................................................................ 3 List OF TABLE and figures ........................................................................................................... 5 Acronym List .................................................................................................................................. 6 Executive Summary ........................................................................................................................ 7 1.0 Background ............................................................................................................................... 9 1.1 Description of the cStock approach .................................................................................... 10 1.2 Other design considerations ................................................................................................ 14 1.3 Roll out of the intervention ................................................................................................. 15 2.0 Endline Evaluation Methodology ........................................................................................... 15 2.1 Data collection tools ............................................................................................................ 17 2.2 Sampling.............................................................................................................................. 17 2.3 Use of smart phones for data collection .............................................................................. 18 2.4 Enumerator Recruitment and Training ................................................................................ 19 2.5 Data Management and Analysis .......................................................................................... 19 2.6 Review of cStock dashboard ............................................................................................... 19 3.0 Limitations .............................................................................................................................. 20 4.0 Summary of findings............................................................................................................... 20 4.1 Training ............................................................................................................................... 20 4.2 Supervision .......................................................................................................................... 21 4.3 CStock ................................................................................................................................. 22 4.4 Meetings .............................................................................................................................. 27 4.5 CHV Reporting ................................................................................................................... 29 4.6 Performance in Key indicators from cStock dashboard ...................................................... 30 4.7 CHA Requesting and Resupply .......................................................................................... 33 4.8 Transport ............................................................................................................................. 35 4.9 Storage of health commodities by the CHVs ...................................................................... 35 4.10 Communication ................................................................................................................. 36 4.12 Stock Status ....................................................................................................................... 36 5.0 Summary of Findings in relation to mHEALTH evaluation framework ................................ 40 5.1 Feasibility (easy to use, learn, relevant and practical) ........................................................ 40 3 JSI Research & Training Institute, Inc (JSI) 5.2 Acceptability (integrated as routine practice and perceived benefits) ................................ 40 5.3 Effectiveness ......................................................................................................................