Thoughts from the Last Mile Welcome to the VillageReach Blog
04.29 2010

I’m sure many of you browsing this blog are familiar with C.K. Prahalad’s groundbreaking book,The Fortune at the Bottom of the Pyramid. In his book Prahalad offers us insight into the vast, potential wealth that exists among consumers at the Bottom of the Pyramid (BoP). In fact, he’s talking about over 4 billion people and a multitrillion-dollar market. Although the “poor” are often categorized in a single group, he argues that they are just as – if not more – conscious about price, quality brand image, and accessibility as the “rich”. He believes that if a company/organization intends to succeed in tapping into the fortune at the BoP, it must study and understand the varied needs of the “poor”.

One of our goals with the USAID-VidaGas project is to develop a business model and toolkit that can be replicated for other BoP products around the world (not just LPG!). We’re using this opportunity with VidaGas to find out how one can successfully learn about and reach clients at the BoP level. LPG, as a new technology with significant benefits, provides us with a great product to find out how we can design an effective BoP model.

We begin with surveys among households to get a better idea of their current fuel usage situation, the perception of LPG, and to identify certain areas of the bairro (or neighborhood) that would be more open and financially capable of purchasing LPG. This is an important step in our marketing campaign as it gives us a better idea of the types of market segments that exist within the bairro. Not everyone is a potential LPG customer and our job is to sift through this diverse market to identify those that fit our client profile.

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We follow the surveys with promotional events such as local demonstration of around 10-20 attendees and Big Events of over 200 attendees to further spread the word about LPG and VidaGas. Not only do these events allow us to demonstrate the benefits of using LPG but they also provide an opportunity to answer any question or concerns about LPG. (Often time’s people think that using LPG is very dangerous, too expensive, or difficult to use.) These events also initiate word of mouth among households which is a crucial aspect in the BoP market as traditional mediums of advertisements often do not reach these households. Our final step is follow-ups among households that attended the demonstrations and Big Events. We want to find out whether or not they decided to purchase an LPG kit, and why they made that specific decision. It also gives us an opportunity to make another pitch to use LPG as people often attend the event but forget about it soon afterward.

Throughout the steps shown above, one of our main goals is to learn. As mentioned earlier, the “poor” are not simply the “poor” but conscientious consumers who want to get the best deal whether it be in price, quality, brand image, or accessibility. Eventually all this learning will help us develop a robust yet flexible model and toolkit that we can apply to other BoP products!

Peter Nakamura, Project Administrator

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04.19 2010

March was the month that we began to make significant strides with the project. We gained permission from the community leader of the Namicopo bairro (neighborhood) to conduct our awareness campaign. Fernando, our Lead Promoter, has been busy developing a “toolkit” of resources for the market analysis, and putting together a team for the campaign. He was able to identify and hire four Promoters and a team of “Animators” that will assist him in the execution of various aspects of the project. The team is comprised of people from the bairro who provide insight and a key link into the community.

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After our Promoters and Animators became knowledgeable and comfortable with using LPG, we conducted a household survey within the bairro. The objective of the survey was to get a better sense of the income situation among the households and their interest/willingness to purchase an LPG stove. A week of surveying provided us with 200 completed surveys!

After completing the surveys (which are currently being tabulated and analyzed), our next task was to send our Animators into the bairros to conduct a demonstration on how to use a basic VidaGas LPG kit. We asked each Animator to find at least 10 people to attend the demonstration and to show the basics on how to use a LPG stove. IMG_0669It was also an opportunity to answer any questions or concerns about LPG as people here often have limited (if any) knowledge of liquid propane gas. I followed one of our Animators (Cecelia) and Promoters (Marino) to one of their demonstration locations which was located at one of the secondary schools in the bairro.

The turnout was quite impressive, and the teachers at the school showed quite a bit of interest in LPG. A wild card in all of this was the vast number of students that also attended this particular demonstration, as they can bring the word about gas to their parents. Now this is viral marketing!

Suffice to say, March has definitely been an exciting month. April should also bring much of the same excitement as we will be hosting our first few “Big Events” in the bairro with music, skits, food, and – of course – LPG! The objective, through the event, is to create even more awareness and interest in LPG/VidaGas, and hopefully some new customers. We also plan on moving into new bairros during April and so adventure continues!

Peter Nakamura, Project Administrator

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04.08 2010

IMG_0669My name is Peter Nakamura and I am one of the newest members of the VillageReach team. I am currently based in Nampula, Mozambique to help coordinate a project funded by USAID to help individual households gain access to propane. The project is coordinated through VillageReach and its social business, VidaGas – the largest distributor of LPG (Liquid Propane Gas) in Northern Mozambique. As the next step in its growth, VidaGas is working to expand its customer base to households in order to diversify its clientele and expand the availability of a cleaner and more efficient source of cooking fuel than charcoal or wood (which are the most common types of cooking fuel in Mozambique).

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In order to increase the demand and awareness of LPG among households, we will be launching a social marketing campaign tailored to the realities on the field. From personal demonstrations of around 10 people to big events where we expect over 200 people to attend, we will be testing different methods to stimulate demand and awareness. In the end, our goal is to be able to learn from this experience and create a social marketing model and toolkit which we will be able to implement in other developing countries and with a variety of product (whether that be bed nets or batteries).

Check in regularly for updates on our progress.

Peter Nakamura, Project Administrator

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02.18 2010

Last night my husband and I watched as Olympic speed skater Shani Davis won the gold. Unfortunately for us, we didn’t experience the thrill of surprise in his victory because NBC airs the program hours after it happens and we had read the news earlier in the day. My husband informed me that many frustrated viewers wrote to NBC requesting live coverage of the Olympic games. “Did it work?” I asked and was told no. I suppose we’ll watch Shaun White compete for gold too (even though we already know he wins).

Did it work? This question is integral to our lives. Did my Toyota come to a stop when I pressed the brakes? Did my headache go away after I took Tylenol? We don’t always realize it but we are constantly conducting evaluations. These questions and answers contribute to our understanding of what works and what doesn’t work so that we avoid repeating the failures.  The concept is pretty simple, so shouldn’t it also apply to the health programs we support?

It appears that the importance of evaluation in health programs is gaining attention. Perhaps this is in response to Moyo’s argument that $1 trillion in international aid has actually increased poverty and the shocking lack of evidence to the contrary. Last fall, I attended a lecture by Richard Horton, Editor of the Lancet, at which he urged the global health community of Seattle to use their expertise to support critical evaluation of global health data. President Obama’s recently announced Global Health Initiative highlights the need for robust monitoring and evaluation efforts in order to accelerate best practices and impact. Furthermore, donor communities are increasingly demanding evidence of impact from the organizations they support. With increasing attention on the importance of evaluation, the global health community is turning their efforts to the improvement of metrics, data, and evidence.

Barriers to the evaluation of global health programs are not insignificant. Evaluations are expensive, time consuming and highly political. For one thing, donors typically want their contributions to go to strengthening a health program rather than to a study of it. Furthermore, many government and non-government organizations fear finding evidence that their programs are not successful and potentially lose funding. Despite the difficulty, expense, and potential for undesirable results, conducting rigorous evaluations of our programs is one of the most valuable things we can do. Only with evidence can we attempt to answer the question of “does it work?”

-Jessica Crawford

Program Associate

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02.02 2010

Reliable delivery of medicines, vaccines, and health commodities at the last mile of the supply chain has been the focus of VillageReach since our inception. Earlier, we discussed the challenge of conveying our message and our work when the issues are complex, relatively unknown in the United States, and difficult to describe. We are happy to report, however, that awareness has been growing with help from articles like this one, found in the most recent winter issue of Global Health Magazine. Prashant Yadav, professor of Supply Chain Management at MIT-Zaragoza, outlines the many successes in Global Health but identifies critical gaps in health delivery.

“In my opinion, the weakest link in the chain now is the in-country distribution system. The costs of ignoring this key part of the health system can be extremely high.  A key reason for the poor performance of the in-country supply distribution system is the lack of an institutional and governance framework on how to organize in-country distribution.”

With keen insight, Professor Yadav articulates the challenges VillageReach faces daily in creating sustainable systems for the delivery of basic, life saving supplies. In addition to this article, Global Health Magazine posted a blog just a few days ago challenging various health system misconceptions.  The article challenges some widely held assumptions, many of which VillageReach has heard repeatedly over the years from potential donors and partners:

• Health systems can’t be measured.
• We don’t know what works to strengthen health systems.
• Strengthening health systems will be a money pit, an expensive, open-ended investment that won’t show measurable results.

Challenging these statements, the article cites the availability of measurable and proven methods within health systems, which can allow practitioners to make vital decisions. We were excited to see these acknowledgments, as a cornerstone of the methodology at VillageReach is the measurement and evaluation of our programs, and through our rigorous evaluation we have proven that health system strengthening programs can not only result in measurable impact but impact that tangibly saves lives.  We hope that these publications represent a shift of perspective within the world of Global Health towards a new view that will see “last mile” health delivery systems as a critical piece of the larger picture.

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01.11 2010

Previously, VillageReach held a discussion on the strategic balance between emotional donation appeals versus more systematic explanations of our work.  NGOs such as Kiva have utilized the advent of the growing social media and net space to reach a wider audience through the vehicle of a recipient to lender connection. Are there unintended consequences that will flow from an over reliance on social media vs. traditional face-to-face connections?  How have NGO strategies and messages changed with the introduction of a more pervasive web and social media presence?  How can NGOs best promote their work and gain connections through the web and social media?

Ultimately, what role does social media play in promoting the work of NGOs?

My name is Alexa and I am first year college student currently volunteering for VillageReach.  I have spent the last week researching different blog sites maintained by practitioners (examples researched include The Acumen Fund and Frontline SMS), research centers (The Center for Global Development), foundations (The Skoll Foundation), academic blogging vehicles (The Stanford Social Innovation Review and The Duke Sanford School of Public Policy), donor communities (GiveWell and Tactical Philanthropy) and independent blogging sites (Good Intentions are Not Enough and Blood and Milk).  The purpose of this research was to identify online communities where VillageReach could engage with practitioners, researchers and donors, raise awareness of VillageReach and network with different organizations and individuals.

I found it compelling to learn more about how different organizations and individuals utilize blogs to promote new ideas, engage with their donors, make announcements and network.  Additionally, some of the most successful non-profits have revolutionized the new social media/network space for fundraising and to create awareness. For example, Kiva’s and Heifer International’s on-line models parallel a function offered by Facebook.  In its configuration, sending a friend a birthday gift of a goat graphic over Facebook does not differ greatly from giving a goat in the name of a friend through Heifer International. Kiva draws its strength through an emotional connection a donor draws through a photo of a recipient and through lender groups. The ever evolving web has changed the rules of the game when it comes to how non-profits structure their models, raise awareness of their cause and fundraise.

My research has guided me to raise several questions on how VillageReach should further engage and connect with other organizations, individuals and donors through the web as well as how other organizations view the web/social media as a tool for their overall mission.

1.)   How has your NGO modified their marketing/communications approach to engage in online opportunities and culture as well as to establish a social media presence?

2.)    What role do social networking sites such as Facebook/Facebook causes play in the work of NGOs?

3.)    How can the blogosphere help to unite fragmented divisions such as public/private sectors, multi-lateral sectors and NGOs?

4.)    Many non-profits such as Oxfam, Charity:Water and Amnesty International, etc. offer opportunities and resources for high school and college aged students to become informed on issues pertaining to poverty and human rights, to take action for a cause and to fundraise on behalf of the NGO.  What role should youth play in VillageReach’s mission/work?


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12.22 2009

Peter Singer’s new book, The Life You Can Save, has sparked a growing debate amongst VillageReach staff. In his chapter, Why Don’t We Give More, he writes about the power of an identifiable victim — as opposed to group or mass need.  He describes Paul Slovic’s research that identifies two distinct ways that we process a call for action. The first is derived from images or stories real or imagined that target an emotional response. The second is based on logic and abstract thinking and can take much longer before we act. Consequently, “the identifiable person moves us in a way that more abstract information does not.”the_life_you_can_save.large-732235

Certainly this concept is not new as non-profits flood their year-end marketing appeals with individual sponsorship programs and passionate stories of hardship and suffering. Kiva is a perfect example of the power of connecting to the individual as they market to donors with a personalized story and photo of each borrower.  So what is our debate about you ask? The question in the office is: If this type of marketing works, and research shows that it does, shouldn’t VillageReach change its message to focus more on individual stories and less about systems?

Up until now, VillageReach has presented its message and for that matter, our brand, as a social enterprise. We are capacity builders and have been recognized as one of the top non-profits for our cost effectiveness in strengthening healthcare systems.  Our work directly impacts those children who so successfully appeal to donors. Yet, this is our challenge. If we focus on the child who we are able to save through immunization, do we lose the opportunity to educate donors on the critical importance of systems building and social change? Do we lose the chance to describe the complicated and sophisticated nature of what we do?

Perhaps this is not black or white and just as any good fund development or marketing manager knows, you need different messages for different audiences. Yet, Professor Singer’s book has given us an opportunity to step back and discuss how we tell our story to current and potential donors.  And wherever we land at the end of this debate, we know either way the most important message of all is in our ability to save a life. That we all agree on. What are your thoughts?  Join us in this debate.

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12.14 2009

IMG_0669With our focus on last-mile healthcare access for remote rural populations, it may sound like a contradiction to address the pressing challenge of improving access for urban populations.  But in 2010 that’s exactly what we’ll be doing.  In August and September we were in India to look at locations for a new vaccines distribution program, and to facilitate a workshop of local and regional NGOs, UNICEF, the Ministry of Health and Family Welfare (MOHFW), and the corporate sponsor of the program.  One of our site visits included a trip to one of Mumbai’s largest slums, built right on top of the city’s main garbage dump.

The workshop highlighted inadequacies of the cold chain in addressing the government’s immunization goals, critical gaps in energy, communications, and transportation infrastructure that exist for many last mile communities; and that health workers are overburdened due to the scope and scale of their day-to-day work.  Not surprisingly, our experiences in sub-Saharan Africa are addressing these same issues.

How did we get from rural to urban?  As part of the workshop we included discussions on India’s population growth and industrial development that is leaving millions behind in rural communities throughout the country.   The three states of Bihar, Madhya Pradesh and Uttar Pradesh make up over 50% of the country’s estimated 10 million unimmunized children.  That’s the largest unprotected population of any one country on the globe. The great majority of theses states’ children are the very rural poor.   But two of these states also have the highest child mortality rates for urban poor communities in the country, which highlights the correlation between the rural poor and the rapid urbanization of the country, as desperate migrating families look for employment.  Dr. Siddharth Agarwal of the Urban Health Resource Centre, based in Dehli, is a passionate and persuasive advocate for these urban slum communities.

Not unlike remote rural communities, urban slum populations are difficult to reach.  There is weak physical infrastructure, limited reliable health services and poor documentation of the populations.

IMG_0660The plight of India’s city slum dwellers certainly isn’t a new topic … Mumbai’s Dharavi Slum of “Slumdog Millionaire” fame helped ensure that, but that the task of improving last mile healthcare access for the urban underserved is strikingly similar to that of rural communities, certainly may be.

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12.03 2009

This week VillageReach President, Allen Wilcox, will be speaking at the 2nd Annual Global Health Supply Chain Summit.  The theme of this years conference is “Bringing Government, NGOs, and Academia Together: What can be learned from the for-profit world?”  We are excited to be included in this conference again this year- the theme alone could be a subtitle for VillageReach’s mission.  Allen will be speaking about what logistics and supply chain bring specifically to the last-mile.  VillageReach’s experience shows that since the last-mile is often much weaker than the rest of the health system, programs can have a disproportionately large impact by effecting change at this level.  Our colleagues at the Zaragoza Logistics Center have been doing terrific work bringing their academic backgrounds to bear on problems in global health supply chains.  As the “implementers” in the field, VillageReach has found that working with academics provides them with a useful real-life case study and provides us with access to sophisticated, cutting-edge, cross-sector knowledge and best practices, so far it’s really been a win-win and we are excited to continue the work.

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10.09 2009

CIMG4849A few weeks ago I traveled to Malawi to work on two projects that use SMS phone technology. One of these projects focuses on providing community health workers (CHW) with an easier and quicker way to communicate with their local hospital, supervisors, and fellow community health workers. I spent an afternoon with 18 of the 21 CHWs in the Kwitanda province to understand how they would utilize such technology, and used that information to develop use cases (e.g. outbreaks, inventory shortages, emergencies, etc.) that will help them provide better health care to villagers in their catchment areas. For the other project, I met with shop owners, assessed the medicines they sell, and discussed the benefits of inventory management with them (which is of personal interest to a supply chain person like myself). The insights I gained through interacting with CHWs and shop owners were then funneled to our technology team, which is working on our upcoming Management Information System (vrMIS3).

I am excited about the potential that these two projects will have for those working in rural and remote areas with poor road and electricity infrastructure and for us, who will be able to collect real-time information about what the needs are in the field and how we can develop programs and innovative approaches to strengthen health systems at the last mile.

Although my time in Malawi was quite busy, I was glad to have had the chance to visit an under-5 clinic, where large numbers of women brought their children to be weighed (for growth monitoring purposes) and to be immunized. In Malawi, like in most of the world, women spend their days collecting water and firewood, washing clothes, caring for handfuls of children, tending to their fields, and preparing meals. Yet these women were willing to put their other duties on hold so that their children could receive vaccines and have a chance at growing up healthy. The health workers in Kwitanda have done a great job at educating these women about the importance of vaccines and health care for their children.CIMG4923

-Jessica, Logistics Manager

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Malawi healthcare worker