Thoughts from the Last Mile Welcome to the VillageReach Blog
09.28 2016

In late August, VillageReach welcomed a team of Wharton Business School students to work on a short-term pro bono consulting project, aiming to develop a diversification strategy for VillageReach in Mozambique.  Although the team spent only nine days on the ground in Maputo, the project had been months in the making, starting with an initial dialogue between Ruth Bechtel, the Mozambique Country Director, and Wharton team leader Joelle Birge back in fall 2015. Coming from a variety of backgrounds, these four students were inspired to travel to Mozambique by their common interest in international development and global health. Joelle describes the work this team accomplished:

oneProject planning began with a series of calls between VillageReach and the Wharton team to refine the project scope and map out work plans and deliverables. Together with VillageReach, we decided that one of the best ways to leverage the team’s time in Maputo would be conducting interviews with public health stakeholders to gain an outside-in perspective on current areas of need and opportunity.  Over the course of the spring and early summer, we conducted research on donors, NGOs and government organizations operating in Mozambique public health and used this research to work with VillageReach on defining a list of priority stakeholders to interview.  This interview list served as the jumping off point for structuring the our on-the-ground work in Maputo.

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09.20 2016

final-20-report-coverWhile visiting rural health units outside Montepuez district in Mozambique, I met a mother at Naioto clinic. It had taken her two hours to get to the facility, with a baby on her back. She was happy to stand in a queue for vaccines for her baby because vaccines were available. The nurse at the clinic, Ana Bendita Miguel, remembers times when she had to turn these mothers away. Prior to ensuring regular, monthly distribution of the provincial delivery truck, it wasn’t uncommon for Bendita to ride a bus to the district centre, a difficult trip of 68km to collect vaccines. In addition to taking Bendita away from seeing patients at the clinic, the bus fare cost her 240 MZN (around $3.30), which was not refunded. In those days she said, “when I didn’t have money for bus fare, I couldn’t prevent the stockout.”

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09.19 2016

VillageReach is always seeking out new ways to improve access to quality healthcare at the last mile, and new partners that allow us to do this. Over the weekend, VillageReach president Evan Simpson presented at the Med25 Benefit dinner. Med25 is an exciting global health organization that provides quality, culturally appropriate and affordable health care by encouraging the creation of local, income-generating businesses that support healthcare initiatives. Together, VillageReach and Med25 are partnering to explore how the Med25 model can be brought to new communities. At this recent event, Evan Simpson shared his insights on the potential impact of this partnership:

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09.15 2016

dscn3648Transformational change does not always happen overnight. In the case of immunization supply chains (iSC), real transformational change requires iteration. It is a process of continuous improvement: cycles of thinking, testing, and improving to constantly push the system forward. While the final result might be a complete redesign of the end-to-end supply chain, each step along the way is a necessary part of getting to a better model. Sometimes the wheels of change move quickly, when political will is aligned with resources and capacity. Sometimes the wheels move more slowly, during phases of learning and refining new ways of doing things. With any large-scale change, the key is to never stop moving forward.

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09.09 2016

Reposted from Next Billion

truck4_moz_2014Vehicle graveyards are an all-too-common sight for those of us who work in global health. These long-forgotten vehicles serve as reminders to the underlying obstacles faced by transport systems throughout Africa. Routine maintenance required to keep cars, trucks and motorcycles moving simply does not happen, shortening the lifespan of the vehicles that are essential to delivering health commodities to the most remote communities.

For the donor community, these vehicle graveyards are a reminder of the weak return on investment for these expensive, short-lived machines. Many institutions are declining to fund the capital expenditure required to purchase vehicles, parts or storage facilities. Insufficient capital is just one of the contributing factors limiting the transport capacity of a health system.

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09.02 2016

Emmanuelle Assy 2016The goal for global health innovation is to identify successful approaches and move them to scale – reaching as many underserved communities as possible with improved access to quality healthcare. Sometimes this is accomplished with new partners or transitioning greater ownership to country governments – but sometimes successful scaling is about sharing what we’ve learned.

Emmanuelle Assy’s job is just that. As VillageReach’s Immunization Supply Chain Improvement Manager, Emmanuelle works with stakeholders, partners, and governments around sub-Saharan Africa to introduce and explore new tools and approaches that challenge the status quo of existing supply chains. For example, she leads computer simulation modeling exercises, which help countries understand different options for making an immunization supply chain more efficient and cost effective. By reducing the risk to bold new ideas, these modeling exercises help government stakeholders think more broadly about their supply chain system and the importance of system design.

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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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