Lessons from quality collaboratives for community level supply chains: Using peer-to-peer learning to improve supply chain knowledge and practices amongst CHWs in Rwanda

Background: In Rwanda, community health workers (CHWs) treat children under five for pneumonia, diarrhea, and malaria. A 2010 baseline assessment of the community supply chain identified a lack of logistics knowledge and skills among CHWs and resupply point staff and low CHW motivation s for supply chain tasks as barriers to CCM medicine availability.

Methods: The SC4CCM Project partnered with three district health teams to implement Supply Chain Quality Improvement Collaboratives (QCs), establishing and training a network of 44 Quality Improvement Teams (QITs), of CHWs and health center staff to find team-led solutions for improving community resupply procedures. The QITs used tools to identify key challenges, set targets, and test their own innovations, addressing performance gaps. The goal was to generate best practices using a continuous plan-study-do-act cycle of assessment and improvement.

Results: The implementation period included monthly meeting support and quarterly, joint QIT meetings at the district level, sharing results across QITs and gauging progress. Using feedback, the QIT tools adapted to be more appropriate for the CHW context. During the final learning session, all QITs came together to identify learnings from the QC process and develop a package of supply chain best practices for national scale-up to improve supply availability.

Conclusions: Increased collaboration and fora to spread changes quickly across many teams can improve problem solving approaches to supply chain challenges. Because the QIT approach stresses local teamwork to identify problems and use of data to determine solutions, QC results ensure solutions are feasible and locally appropriate.