BackgroundMalaria rapid diagnostic tests (RDTs) are particularly useful in low-resource settings where follow-through on traditional laboratory diagnosis is challenging or lacking. The availability of these tests depends on supply chain processes within the distribution system. In Mozambique, stock-outs of malaria RDTs are fairly common at health facilities. A longitudinal cross-sectional study was conducted to evaluate drivers of stock shortages in the Cabo Delgado province.MethodsData were collected from purposively sampled health facilities, using monthly cross-sectional surveys between October 2011 and May 2012. Estimates of lost consumption (consumption not met due to stock-outs) served as the primary quantitative indicator of stock shortages. This is a better measure of the magnitude of stock-outs than binary indicators that only measure frequency of stock-outs at a given facility. Using a case study based methodology, distribution system characteristics were qualitatively analysed to examine causes of stock-outs at the provincial, district and health centre levels.Results15 health facilities were surveyed over 120 time points. Stock-out patterns varied by data source; average monthly proportions of 59%, 17% and 17% of health centres reported a stock-out on stock cards, laboratory and pharmacy forms, respectively. Estimates of lost consumption percentage were significantly high; ranging from 0% to 149%; with a weighted average of 78%. Each ten-unit increase in monthly-observed consumption was associated with a nine-unit increase in lost consumption percentage indicating that higher rates of stock-outs occurred at higher levels of observed consumption. Causes of stock-outs included inaccurate tracking of lost consumption, insufficient sophistication in inventory management and replenishment, and poor process compliance by facility workers, all arguably stemming from inadequate attention to the design and implementation of the distribution system.ConclusionsSubstantially high levels of RDT stock-outs were found in Cabo Delgado. Study findings point to a supply chain with a commendable degree of sophistication. However, insufficient attention paid to system design and implementation resulted in deteriorating performance in areas of increased need. In such settings fast moving commodities like malaria RDTs can call attention to supply chain vulnerabilities, the findings from which can be used to address other slower moving health commodities.

In low-resource settings in developing countries, most records are still captured and maintained using paper forms.Despite a recent proliferation of digital data collection systems, paper forms remain a trusted, low-cost and ubiquitous medium that will continue to be utilized in these communities for years to come. However, it can be challenging to aggregate, share, and analyze the data collected using paper forms. This paper presents mScan, a mobile smartphone application that uses computer vision to capture data from paper forms that use a multiple choice or bubble format. The initial mScan implementation targets the task of digitizing paper forms used to record vaccine statistics in rural health centers in Mozambique. We have evaluated the accuracy and performance of mScan under a variety of different environmental conditions, and our results show that mScan is a robust tool that is capable of accurately capturing and digitizing data from paper forms.

We describe our experiences integrating ODK Scan into the community health worker (CHW) supply chain in Mozambique. ODK Scan is a mobile application that uses computer vision techniques to digitize data from paper forms. The application automatically classifies machine-readable data types, like bubbles and checkboxes, and assists users with the manual entry of handwritten text and numbers. We designed an intervention that uses paper forms in conjunction with ODK Scan to monitor CHW usage of essential health commodities, finding that the application is capable of providing supervisors and stakeholders with important information regarding health commodity availability in the field. Specifically, we (1) detail our experiences integrating ODK Scan into the health worker supply chain in Mozambique, with particular emphasis on the critical (and often under-reported) role of practitioners; (2) evaluate the impact of the technology at multiple levels of the information hierarchy, providing quantitative and qualitative data that exposes the benefits, challenges and limitations of the technology; and (3) share lessons learned and provide actionable guidance to researchers and practitioners interested in ODK Scan or other systems that bridge the gap between paper-based and digital data collection.