RESUMEN
Objectives: In Haiti, limited coverage of Vitamin A supplementation (VAS) in children under 5 years of age is associated with a weak and fragmented health system. To address this, the government and partners implemented a process to identify and remedy problems and bottlenecks. Methods: Evaluative activities that were conducted include: 1) participative and de-centralized stakeholder workshop to assess the Child Health Week (CHW) platform for distributing VAS; 2) NGO-mapping conducted in all 10 Haitian departments; and 3) interview-based and observational supply chain assessment. Results: Each assessment highlighted enabling factors and barriers for improving coverage of VAS in Haiti. 1) The CHW workshop identified weak national program coordination and ownership, and bottlenecks in data collection and reporting. The existence of trained departmental data managers was identified as an opportunity to improve VAS Program reporting. 2) The NGO mapping identified 43 organizations currently involved or interested in getting involved in the VAS program, which can serve to extend program reach. Inadequate knowledge of VAS protocols by NGO personnel was limiting their potential involvement. 3) The supply chain assessment identified inadequate forecasting, a fragmented stock management system, and under-utilized supply warehouses. New stock management tools and opportunities for shared transportation represent potential areas to improve the supply chain. Conclusions: Strengthening the health system in Haiti remains a long term goal. These three assessments identified short term strategies - including synergies with existing health resources and utilizing the capacity of NGOs - that could help improve coverage of the national VAS program.
RESUMEN
Objectives: The broad objective was to assess components of the supply chain aiming at identifying facilitating factors and barriers to uninterrupted availability of IFA, oxytocic drugs, misoprostol, magnesium sulphate and calcium with a view of formulating innovative solutions. Methods: A cross-sectional design was used to conduct supply chain assessment in Kakamega County, Kenya. It included a random selection of 7 dispensaries, 8 health centres, 3 district hospitals and 1 referral hospital. Data was collected through record reviews, observations, key informant interviews and client exit interviews. Results: The study found glaring gaps in commodity forecasting and quantification, sub-optimal inventory management, and there were frequent prolonged stock outs. Commodity specific gaps were identified including lack of inclusion in the essential drugs list, absence of service delivery guidelines and a large proportion of commodities available in the market that did not meet the recommended dose composition for the intended purposes. For example, only 12% of the combined IFA formulations found in the market met the recommended doses for antenatal supplementation. There was also inadequate local manufacturing capacity of these commodities. Conclusions: In conclusion, there are glaring weaknesses in the supply chain. Streamlining the supply chain entails addressing policy issues, advocacy for local manufacture, strengthening forecasting and quantification capacity as well as a carefully thought out procurement processes.