VillageReach strives to be a learning organization. We are trying to increase access to healthcare in countries where the roads are impassable, electricity and cell phone networks are intermittent – if they exist at all, half the population is illiterate, and almost 10% of children don’t live to see their first birthday. It’s not easy, to say the least. Some days I see stories of success and I am proud of the work we do. Some days I am reminded that this is an uphill battle bigger than the likes of any mountain I have ever seen, and I search for better paths to the top.
In Mozambique, we have been working for two years to implement a national expansion of a logistics system for vaccines and other medicines. Our efforts have focused on four provinces, which cover nearly half of the country. So how is it going? I’d say it’s time for adjusting our hiking path. Our biggest challenge is securing that the distribution system is reliable; logistics without reliable distributions in terms of quantity, quality, and timing undermines health services and access to those health services. When distributions are delayed or incomplete, we find health facilities without stock of critical medicines. This is a problem for us because funding to the government for the distributions is often delayed or funds are simply not available from the government despite all the required components being there (budgets, plans, funds requests, political will, etc). We set up this national expansion with a vision that the government would support its own costs because sustainability has been a top priority for us. However, that sustainability can come at the expense of results.
As a learning organization, trial and error is a part of our work. We tried an approach with sustainability as a main driver, but we have been forced to re-examine the approach because we value results. Our work is to achieve results. Now it’s time to try a adapt our approach. We aren’t willing to throw out sustainability, so we need to find the magic balance between results and sustainability. Now we are embarking on a cost-sharing model. We will continue our close collaboration and capacity building of the government systems, but also address the very real challenges of funding critical pieces. This requires additional effort in consideration of sustainability, but we are up to the challenge.
The challenge of funding a reliable logistics system has been our biggest lesson learned from the first year of the national expansion. We’ve also learned that providing technical assistance to a logistics system requires more intense monitoring than implementing a logistics system. This has implications on our staffing structure and level of expertise, so we have hired additional staff in our Maputo office. We’ve found that progress with this approach is slower than anticipated because our work is more dependent on schedules, funding, priorities, and staff of the government, which must constantly balance priorities in an under-resourced environment. For example, the logistics system involves government staff collecting data to analyze the performance of the logistics system. In our pilot project in Cabo Delgado province from 2002 – 2007, those staff were ours. When we trained them on data collection and made it a part of their job, they did it. In using government staff to do this, the staff need to balance other activities and we need to work more with management to help them understand the value of the activity and include it as a priority. As we learned this, we’ve adjusted our plans and expectations. Finally, we’ve been working to incorporate Rapid Diagnostic Tests for HIV, malaria, and syphilis into the logistics system. This integration has encountered operational and political challenges as additional people and departments are involved in the logistics and use of tests so we’ve had to focus more on establishing routine and comprehensive coordination and communication. Months from now we will certainly be mulling over lessons learned from this modified approach, and we’ll adjust our paths to the top of the mountain again.
Leah Hasselback, Mozambique Country Director