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Table 4 Challenges and solutions for drug supply and supervision identified by managers and HSAs

From: Health systems supports for community case management of childhood illness: lessons from an assessment of early implementation in Malawi

Challenges identified by participants Solutions implemented by districts
Drug supply
• Distance from HSA posts to health facilities and lack of transport • Pharmacy technicians deliver drugs to HSAs at their posts
• District managers allow HSAs to collect emergency supplies of drugs from the district hospital stores
• HSAs working in the catchment areas of health facilities operated by the Christian Health Association of Malawi (CHAM) are unable to collect drugs from their nearest facility due to conflicts in user fee policies • District managers reach an agreement to reimburse CHAM for drugs supplied to HSAs
• Resistance by health center clinicians to supplying drugs to HSAs when they are unaware of the new program • Orientation sessions held for health center clinicians
• District-level managers lack time to make supervision visits to HSAs’ communities • Assistant environmental health officers and Senior HSAs are included in CCM trainings to enable them to conduct CCM supervision
• Managers have difficulty securing vehicles and fuel for supervision visits
• Managers lack clear guidelines on what activities should be conducted during supervision visits • District managers develop their own supervision checklist, with assistance of partner organizations