Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs. Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives. Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.

Background: This paper explores the extent of community-level stock-out of essential and program commodities for Maternal, Newborn and Child Health (MNCH) among Community Health Workers (CHWs) in Low- and Middle-Income Countries (LMICs), and identifies the underlying bottlenecks leading to such stock-outs.Methods: A systematic literature review was conducted of published and grey literature. 48 studies containing information on the number or percentage of CHWs or health facilities (HFs) stocked-out, or reasons for stock-outs at these levels, were included. In addition, interviews were conducted with domain experts from different organizations working on community health to identify primary reasons for stock-outs. The qualitative data regarding reasons for stock-outs were categorized under different themes, using a content analysis method. Results: 48.09% [CI 95%: 39.28 - 56.90] of the Community Health Workers and 54.76 % [CI 95%: 43.54 - 65.98] of the health facilities in SSA countries included in this study experienced stock-outs of essential commodities. A hypothesis test showed no significant difference in stock-out rates between CHWs and HFs. The most frequently cited reason for CHW stock-outs was a lack of financial resources, leading to inadequate national level stocks, affecting supply available at the last mile. Moreover, issues at HF and CHW levels in the following areas contributed to stock-outs: transportation, data and estimation of needs, human resources, and stock management and storage. These significant bottlenecks hinder the ability of CHWs to save lives.Conclusion: Stock-outs of health commodities impact almost half of CHWs, preventing effective service delivery. Many factors contribute to stock-outs, which occur at all levels of the health supply chain. A system strengthening approach is necessary to reduce CHW stock-outs. Sparse data, differing definitions of stock-outs, and inconsistent reporting metrics posed significant challenges to analyzing results from reviewed studies. Therefore, a set of standard metrics to measure the rate, period, and frequency of stock-outs in future studies is recommended.