ACT stockouts at community health worker posts destroy trust and delay treatment

Community health workers (CHWs) in rural Africa are the front line of malaria case management, diagnosing with RDTs and treating with ACTs in villages that are hours from the nearest health facility. But ACT stockout rates at CHW posts range from 69% to 95% in some regions, meaning the CHW often has nothing to give when a mother brings a febrile child. This matters because every hour of delayed treatment increases the probability that uncomplicated malaria progresses to severe malaria: cerebral malaria, respiratory distress, or severe anemia requiring blood transfusion, all of which are frequently fatal in settings without hospital access. But the damage extends beyond the immediate patient. Once a CHW runs out of drugs, the community stops trusting and consulting them. In Burkina Faso, drug stockouts were cited as the reason for 12% of non-consultations, and utilization did not recover even after stocks were replenished. Years of investment in training and deploying CHWs are undermined by a supply chain failure. The problem persists because CHW drug supply depends on a push-based system where quantities are estimated centrally and delivered on fixed schedules, ignoring actual consumption. Poor roads, absent transport budgets, and lack of real-time inventory data mean that no one at the district or national level knows a CHW post is stocked out until the next scheduled delivery cycle, which may be months away.