Thoughts from the Last Mile Welcome to the VillageReach Blog
08.17 2016

One hundred and thirty minutes. That’s just over two hours. It’s a long time to wait to see a doctor no matter where you are in the world. Then after waiting for two hours, patients talk to a healthcare provider for less than 2 minutes – 140 seconds – before they are back out the door. These are the average times spent waiting for and with healthcare providers in a rural health center in Malawi, where a recent study examined the flow of patients to help uncover opportunities for improvement.

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08.12 2016

IMG_0552Having been in my new role as President of VillageReach only a few weeks, each day is filled with new “firsts.”  First staff meeting, first attempt to work the phone system (failed), first presentation (so-so). Among them was my first—but certainly not last—Final Mile Logistics Working Group Happy Hour hosted by Lynden International. At VillageReach, we focus on increasing access to quality healthcare for those living in the most difficult-to-reach and underserved communities where basic, routine health care delivery is a huge challenge.  For us, supply chain and logistics are essential elements of addressing that challenge, so it was great to meet and talk with representatives and leading thinkers from Puget Sound-area companies and our WGHA colleagues who share our interest, have a passion for new ideas, and apply them on a global scale.  Who better to help us think through the challenges and opportunities of last mile delivery?

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08.09 2016

As a global health innovator, VillageReach invests great time and effort in exploring how new technologies can be applied to address existing heath systems challenges. Often, this means considering how health system improvements can be leveraged to solve more than one problem at a time. Take, for instance, the emerging Zika virus threat: while VillageReach does not coordinate emergency disease response, our work improving routine transport of medical commodities could be used to strengthen emergency efforts. Similarly, emerging and innovative technologies, such as unmanned aerial vehicles (UAVs, commonly referred to as drones) could add to this comprehensive approach to healthcare improvement.

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08.08 2016

DSCN3523Immunization supply chains have not changed much since they were first conceived in the 1970’s. Most ad-hoc efforts to improve these systems, like increasing storage or transportation capacity, have not been effective in dealing with modern day demands on these systems. It is estimated that between 2010 and 2020, immunization services will require twice the storage and transport capacity to manage four times the vaccines. With this unprecedented expansion, workers at all levels of the supply chain feel the burden of supply chain inefficiencies. This extra burden, particularly at the service delivery points, results in low vaccine coverage rates at the last mile. Supply chain managers are beginning to challenge the status quo of their supply chains and embrace innovative approaches for improved performance.

VillageReach, along with CIDRZ and the Zambian Expanded Programme on Immunization (EPI), held a workshop last week in Lusaka to take a holistic look at immunization supply chain (iSC) in Zambia. This workshop brought together national EPI programs managers, decision makers and key stakeholders to identify potential options to make the iSC more efficient.

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08.05 2016

Kwitanda HSA Supervision-6_Malawi_2015_CREDIT_Jodi-Ann BureyMalawi has made incredible strides over the past few years to reduce morbidity and mortality, specifically among women and children under 5 years old. Key to this success has been a focus on using community health workers, known in Malawi as Health Surveillance Assistants (HSAs), to push direct healthcare services throughout the most rural, hard-to-reach, quintessential last mile communities. As a result, people who otherwise may not have reached a health facility can now access basic services from their HSA—sometimes even in their own homes. At the same time, however, more HSAs work in isolation or as the only person from their cadre within their area, with little interaction with colleagues, supervisors or other healthcare providers.

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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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