This idea will be tested in a rural community in Orissa, which has one of the lowest health achievements in India and the world. National Rural Health Mission is a pan-India rural health delivery program which provides services in reproductive, maternal, neo-natal, child health, malaria, filaria, blindness and TB. In a cluster of 2 villages with a total of 5000 people, there is one Sub-Health Centre (SHC) and in a cluster of 6 villages (30,000 people) there is one Primary Health Centre (PHC). Details are available here: http://mohfw.nic.in/WriteReadData/l892s/file35-33319850.pdf.
NRHM has provided with essential drugs and supplies list for SHC, PHC and each health workers. However, facilities and health workers do not have an effective mechanism to report stock status and order fresh stocks. Supply store manager (in district headquarter) also does not react to demands effectively. An effective supply management means i) fast and reliable check of stock status, b) fast order for replenishment and c) store manager who acts upon requests. Traditional paper based system can not solve this problem.
3. Solution approach (activities):
i) Mapping the supply requirements: Since in a given community, number of eligible beneficiaries registered under NRHM is finite and predictable, it is also feasible to predict the stock requirement in SHCs and PHCs, in each category of supplies. There could be additional 10% stocks as safeguard. This analysis of requirements could be done using three databases - a) Register of patients maintained at facilities and health workers, b) NRHM-HMIS database - http://nrhm-mis.nic.in which keeps data at SHC and PHC levels and c) community survey.
ii) SMS: We will then develop an SMS system to allow health workers report stock status in all supply categories and place requisition for fresh stocks. The SMS will be done using a small set of English keywords which will be written in a printed and illustrated pocket guide that will be distributed to all concerned people. The SMS method will be implemented using a commercial SMS gateway and short codes and strings will be developed.
iii) Store manager: We will present this data to the district store manager and other stakeholders - Block Health Manager, CMO, among others. We will also send periodic updates (monthly) on stock requirements. Store manager will receive the SMS from health workers and will act upon those requests. If he does not act upon within 3 days, a subsequent alert will be sent to Chief Medical Officer for him to follow up.
iv) Training: Training in SMS reporting will be provided to health workers, store managers and others involved in supply chain management.
v) Community involvement: Despite this intervention, there is a need for the beneficiary to be able to report stock out status. Using the SMS gateway or direct call, they can register complaints. We intend to publicise this intervention and provision of complaints through wall painting. We would also like to distribute a printed list of essential medicines that should be available with the health workers and facilities among the entire population in the project site.