Bill & Melinda Gates Foundation

Quality Improvement by Candlelight

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April 04, 2016

When the lights went out at the medical office in Taunggyi Township, Myanmar on the evening of September 30, local health workers lit candles and continued their discussion about how to improve the supply chain that provides contraceptives and reproductive health products to the women and families that need them. These health workers are part of a supply chain quality improvement team (QIT) that meets monthly to review data collected through the reproductive health commodity logistics system (RHC-LS), and works to solve observed challenges, like stock outs at service delivery points.

In 2013, as part of the global FP2020 partnership, Myanmar pledged to halve unmet need for family planning by 2020. The efforts of the Taunggyi health workers and many others in Myanmar to strengthen supply chains that deliver reproductive health commodities, are essential to meeting the FP2020 goals – getting products into the hands of women and families, where and when they need them.

In Taunggyi and the six other Townships in two States and Regions where JSI and UNFPA are working with the Ministry to pilot QITs for supply chain, the results are noteworthy. These six Townships showed improvements in three key indicators: reporting rates, stock out rates and facilities stocked according to plan. Since QITs have been implemented in July, 2015, stock out rates in the three QIT Townships in Southern Shan have fallen nearly 20 percent. Encouraged by these results and already realizing the QITs’ benefits, Southern Shan State officials have decided to continue QIT meetings even when the funding for the pilot ends. They recognize the value of these meetings and want to institutionalize them; a critical step to ensuring sustainability.


The success of the quality improvement approach is based on the premise that the availability of data alone is not enough for supply chains to perform and get critical health products into the hands of clients. In addition to building robust information systems, creating a “data culture” by empowering and training staff to actually analyze and use that data is key to making logistics systems work. Now Myanmar has both for reproductive health products – an electronic logistics information system in Logistimo that includes updated dashboards to further facilitate analysis of critical issues, and the teams that know how to use the information available to identify and solve problems.

While the quality improvement team approach seems relatively simple, there is evidence that demonstrates real impact. JSI first piloted and scaled quality improvement teams through SC4CCM, a learning project in Malawi and Rwanda funded by the Bill & Melinda Gates Foundation. The results from this original project found the benefits were rapid, transformative, far-reaching and pervasive. So much so that based on this success, JSI has replicated the approach in Myanmar. In Malawi, the project developed and implemented a mobile phone reporting and resupply system that resulted in improved data visibility and achieved better supply chain performance on indicators such as reporting, complete reporting, and lead time for replenishing supplies. However, supply reliability only improved when quality improvement teams were organized and met on a regular basis to review data and use this information for decision-making (Shieshia et al, Journal of Global Health).  In addition to compelling evidence, participating health staff noted that QITs helped them achieve the desired outcome: getting more products into the hands of clients. One health center in-charge in Malawi said, “We don’t have stock outs because the meetings help us. If we have a problem there is a protocol we follow. We resolve the issues.”

This evidence, and the subsequent experience of using the quality improvement team approach for supply chains in Rwanda, Myanmar, and soon in Kenya, Pakistan and Indonesia, has shown that these teams are essential to creating sustainable supply systems, led by local leaders and staff.

Funding for the pilot implementation of QITs in Myanmar was provided by the UN Commission on Lifesaving Commodities.

Learn more about JSI’s work supporting quality improvement for Myanmar’s reproductive health supply chains. 

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