The Connect Project aims to improve community-level availability, accessibility, and quality of primary health care services using community health agents (CHA) in three districts in rural Tanzania [ 34].
Two studies reported that pharmacists were trained to strengthen stock management at the health facility and maintain the supply chain to the community level; good availability of antimalarial drug stock was reported for both studies during the evaluation.
The usefulness of short and ultrashort screens aside, challenges still exist, for example, it is not clear whether increased detection and referral at a community level or the availability of shorter more reliable screening tools, would necessarily increase nurse responsiveness to community referrals or improve treatment access or cost effectiveness (Hewitt and Gilbody 2009).
Area of residence serves as a proxy for various factors at community level, including environmental factors, availability of health care and support services, and shared cultures.
These may exist at the individual level (e.g., level of income or education, access to a personal vehicle) and at the community level (e.g., physical availability of health services).
Supply chain strategies to improve CCM product availability at the community level must take place in concert with strengthening the entire supply chain and improving product availability at the national level, or first mile, of the CCM supply chain pipeline and at all intermediary levels.
Data availability at the community level can be problematic (Parkins and MacKendrick 2007), but indices used here can be adapted to suit different contexts and data availability.
The cumulative effect of obstacles within these preconditions all contribute to lower CCM product availability at the community level.
Yet there is little understanding of the factors that enhance or constrain product availability at the community level, the last mile of community case management (CCM) supply chains.
Lastly, there is a positive correlation between amphetamine availability at a community level and the incidence of psychosis in the same population [ 41- 44].
The potential existence of factors present at community level such as cost and limited availability of both nets and insecticides, which have been reported to cause low use of ITNs, will need to be explored [ 32].
