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Thoughts from the Last Mile Welcome to the VillageReach Blog
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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09.21 2009

We’re happy to say it’s been a busy month of September here at VR.  While we haven’t had much time to write- others are writing about us!  Over at the Discovery Channel, they cheekily suggest we should get involved in the US healthcare debate (thanks, but no thanks), while the author at the Scientific American blog sees the link between our work and the new Swine Flu vaccine.  Meanwhile, the NextBillion blog covers our panel at the SoCap Conference.

As we move forward into fall, we look forward to even more good news…

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09.03 2009

Greetings from SoCap, the annual gathering of social entrepreneurs and investors here in San Francisco, billed as the largest of its kind in the world.  Yesterday was a flurry of sessions covering topics as varied as India social business developers strengthening remote tribal communities through weaving and arts and craft cooperatives, to new pharmaceutical ventures for low income countries to benefit base of the pyramid communities.

And VillageReach was there too.  Craig Nakagawa, our CFO, and Keely Stevenson, from Bamboo Finance, lead a great session on the just-announced investment in our Mozambique propane business, VidaGas. Titled “Anatomy of a Social Investment,” the session covered the development of the business, its impact on the health system it was created to serve, and Keely and Craig looked at future opportunities for social businesses in Sub Saharan Africa.Helping Hands

A couple of interesting takeaways from the session:

– the need for patient investors in social business ventures is key for both the initial development and long-term sustainability of these businesses.  In our case, VillageReach’s hybrid non-profit/social business model has proven to be very valuable.  Initial investment for VidaGas was supported by donor contributions, that otherwise would have been spent on the purchase of fuel and equipment that VidaGas sells to the market.  We see this approach as a winning formula for donors who are interested in achieving long-term impact for their contributions.

– Keely noted there are few base of the pyramid social ventures operating today.  Some businesses have been created that serve middle-income communities that then attempt to reach out to lower-income consumers, but this can be a challenge where profitability is a requirement.  Keely highlighted VidaGas’ market development approach as ideal, whereby we launched the company with the government health system as our initial anchor client, with some sales to lower-income communities also and then moved up-market to epand sales of the fuel to middle income consumers.

The investment has only just been announced, but we’re looking ahead to the future.  This week we’re meeting with a number of new investors to present a new proposal to broaden our base of household sales.  We’ve put together a comprehensive market development proposal that is intended to add new retailers for propane and stimulate greater interest from communities who have previously had to rely exclusively on charcoal for their cooking requirements.

Onward and upward.

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09.02 2009

After yesterday’s announcement of Oasis Fund’s investment in VidaGas, VillageReach has even more good news to share: VillageReach has been recognized by the 2009 Tech Awards as a Laureate in the Health Awards category!

Each year, the Tech Awards recognizes 15 global innovators who apply technology to the most critical issues affecting the world.  This year, VillageReach was selected from among hundreds of nominations representing 66 countries.  The Laureates are honored at a gala in San Jose in November.

VillageReach’s Management Information System (vrMIS) was recognized because of the significant impact it made in improving information and decision making in VillageReach’s Mozambique program.  Developing countries bear the greatest burden of infectious diseases, but they often have poor infrastructure to support critical public health programs.  VillageReach worked with the government of Mozambique to implement vrMIS which enabled health workers in the field to send and receive data in real time and as a result, empowered health workers to make the best possible decisions based on accurate and timely information.

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