Thoughts from the Last Mile Welcome to the VillageReach Blog
07.27 2016

IMG_0721Often when we talk about methods of delivery in low-resource environments, we are referring to simple solutions. Health commodities arrive at rural clinics on trucks, by bicycle or motorbike, by foot, and sometimes even by boat or canoe. These traditional delivery methods are often faced with simple, but insurmountable barriers. Roads are washed out or are in poor repair. Vehicles are not properly maintained or require expensive fuels. Routes pass through potentially dangerous areas with threatening wildlife. Trying to find new, innovative solutions for these problems has lead VillageReach to UAVs – unmanned aerial vehicles. Last week, I presented at the first meeting of the Final Mile Logistics Working Group, providing an overview of UAVs and the potential they have for filling the delivery gap in global development.

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07.26 2016

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Bringing a program to scale can’t be done single-handedly. It requires the commitment of partners working collaboratively towards a common goal and a dedicated team to keep up momentum as new and unexpected challenges arise. Sometimes, key individuals drive a project forward. They find themselves in the unique position to motivate partners and steward the larger team. Upile Kachila is one of these people.

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07.22 2016
Jessica Crawford spoke about health delivery in last mile contexts.
Jessica Crawford spoke about health delivery in last mile contexts.

Global health innovation requires us to think beyond an individual product – it’s about creating space for “last mile thinkers” to meet with the scientists and engineers whose work influences medicine availability and healthcare access in low- and- middle income countries. This is how VillageReach found itself on a stage next to representatives from GlaxoSmithKlein, Pfizer, Washington Global Health Alliance, and the Controlled Release Society, engaging in conversations about what medicine delivery means in the context of global health.

Tremendous time, resources, and efforts are invested in developing new, more effective medicines that can improve quality of life – some of these medical breakthroughs have promise to control or eliminate diseases that costs thousands of lives each year. But the challenge of delivering these innovations in low-resource settings remains a pervasive barrier to improving health care access and outcomes. New products have unintentionally strained fragile health systems. Health supply chains for example, designed decades ago, struggle today to deliver a wider range of medicines to larger populations. Infrastructure and human resource challenges limit the impact of these innovations. Life-saving medicines sit on shelves in a warehouse, or expire in broken refrigerators at a rural health facility – many of us who live and work at the last mile of rural communities are familiar with this “innovation pile-up.”

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07.13 2016

If someone asked me “what’s a van?” in the US, I’d probably say a big-ish vehicle meant to efficiently move people and stuff from point A to point B. In Africa, these large people movers are called minibuses, kombis or any of a hundred other terms, except van. So when someone asks me about “VAN” in the African context, it means something very different. VAN is an acronym for “Visibility and Analytics Network.” In Nigeria, where VillageReach is working on the VAN project, it represents a new, more holistic approach to vaccine delivery and achieving a healthy, functioning supply chain. Though our VAN doesn’t have four wheels, it’s still purposefully designed to move things around more efficiently.

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07.05 2016

Delivering the Money CoverAt the very least, the flow of funding in vaccine distribution systems is uncoordinated. Not knowing where money is going, when it will be allocated, and how much money will actually be available prevents effective distribution. Ensuring financial resources are efficient and accessible is vital to the success of delivering vaccines to the last mile, yet immunization program managers face a variety of financial bottlenecks, many of which are symptoms of deeper, underlying financial management challenges. A new policy paper, from VillageReach and the William Davidson Institute, explores these challenges in detail. At the heart of the matter, financial flow challenges force decision-making processes into a guessing game, where accuracy is about as certain as a round of “pin the tail on the donkey.”

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06.30 2016

20160614_091644In 2015, VillageReach conducted an assessment of the public health supply chain in two of the most remote and underserved provinces of Democratic Republic of the Congo, the provinces of Equateur and Tshuapa. The results show that the health supply chain is a “casse-tête,” literally, a “head-breaker” – something so complicated and challenging it makes everyone’s head hurt. Equateur Province in particular presents daunting logistic challenges: not only is it isolated, but the “highway” in this region is the mighty Congo River. Medicines must first be transported on a plane or boat from the capital, Kinshasa to the provincial capital, Mbandaka, then another 10 days by boat to reach the zonal health office. From here, medicines are distributed by canoe, motorcycle, bicycle or on foot to the health centers that serve the local communities and sometimes even further, directly to where patients live.

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06.23 2016

Untitled designGraduation season is upon us. It’s a time of reflection for those about to embark on a new phase of their lives. For many this means entering the workforce for the first time, a pivotal life moment.  At VillageReach, we recently celebrated the graduation of the second cohort of pharmacy assistants. Once deployed, these 85 graduates will begin careers as employees of the Malawi Ministry of Health and will be placed in rural, public-sector health facilities across Malawi. The 85 graduates will join their previous cohort who are already working in the field and making significant improvements in the quality of medicines management and patient care at the last mile. But this recent event is not the only graduation we’re celebrating.

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06.22 2016

In 2014, Africa.com published a list of the 10 jobs that will be the most sought in Africa in the near future. It comes as no surprise that logistics and supply chain management related jobs made it to the list, identifying supply chain managers as a driving force of economic growth in Africa.

Me & Dr Mukengeshayi, SG of DRC
Speaking with Dr. Mukengeshayi Kupa, Secretary General of the Ministry of Health, DRC

After attending the recent Immunization Supply Chain Leadership Conference in Abidjan, I felt that this was also true for the public health sector. The eleven African countries represented were all speaking with one voice: they need the right person at the right place to lead the next generation of immunization supply chains (iSC).

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06.17 2016

The differences between West Africa and Southern Africa are well known, even if partially built on generalizations and stereotypes. There are personality differences, language differences, different foods and ways to eat, different and distinct rhythms heard in discotecas. While regions and individual countries are culturally unique throughout Africa, many share the same challenges and goals when it comes to improving their health systems. A few of these similarities stood out when the Ministry of Health in Mozambique hosted a team from the Ministry of Health in Togo this past week. IMG_6533The Togo team—Dr. Napo-Koura Gado Agarassi, Secretary General of the MoH; Dr. Ayi Hervé D’Almeida, Director of Procurement and Inventory Management; Dr. Amevegbe Kodjo Boko, National EPI Director, MoH, Togo – came to Mozambique to better understand how this country runs its supply chain for health commodities and what lessons can be learned between the two countries.

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05.06 2016

Reposted from the Bill and Melinda Gates Foundation Blog: Impatient Optimists 5.6.2016

I recently returned from a week in Mozambique with a goal of learning about new immunization supply chain models and observing their impact.  I also wanted to better understand opportunities and constraints for taking this work to scale — in Mozambique and across other Gavi-eligible countries.

In 2013, the Gates Foundation began working with five provincial governments in Mozambique, the national ministry of health, and VillageReach on a new system for delivering vaccines.  The new system represented big changes over their current design.  It takes a holistic approach – reconfiguring the transport system, re-assigning roles and responsibilities of personnel, obtaining and using data differently, and integrating supervision and cold chain maintenance into monthly vaccine distributions. I was able to get a first-hand view and see some impressive results of this “next-generation” system while in southern Mozambique’s Gaza Province. In Gaza, there’s now a much better chance that when children show up at a health center for immunizations, the vaccines will actually be there.  Vaccine stockouts have dropped from 43% in 2012, before the province revamped their system, to routinely less than 3% today.

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