Thoughts from the Last Mile Welcome to the VillageReach Blog
07.01 2009

We are excited to annouce that VillageReach has been rated as a top charity by GiveWell. GiveWell is an independent, nonprofit charity evaluator- founded by two ex-hedge-fund analysts, GiveWell brings a metrics-based business mentality to the table with their rigorous and thorough analysis of charities.

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It is incredibly refreshing to be asked about more than just our overhead to program ratio- as Anne mentioned in a prior post, we’re always thinking about what metrics we should be measuring our work by and how best to share our successes with our supporters.  We’ve been working back and forth with the guys from GiveWell for the past couple of months and been thoroughly impressed with the amount of work they put into each analysis they do.  We are incredibly proud to have passed their high standards!

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06.19 2009

Interesting article today in the Seattle Times! Even in the eight years since VillageReach was established, it’s been amazing to see how global health funding has fundamentally changed- we blogged before about GAVI and The Optimize Project, two enormous initiatives that would never have happened without the “balance of power shift” mentioned in this article…

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06.17 2009

As a recent MBA graduate, I joined VillageReach for the summer tasked with evaluating our models and frameworks to further reach scalability and create sustainable business opportunities.Throughout business school, I was taught the importance of proving that financial profitability and measurable metrics are essential for making business decisions. Shouldn’t this common standard be used to measure socially-focused investing as well?Our philosophy at VillageReach is that there is a place for social investing in which we can create profitable businesses that have the potential to achieve both a financial and social return. We have proven a case in which the combination of non-profit dollars and entrepreneurism can build a sustainable business.  Whileventure capitalists seek to create financial returns by investing in new technologies, VillageReach aims to improve established energy and logistics platforms to build base-of-the-pyramid businesses. However, unlike the VC world, there is no standard metric to calculate and measure the value of a social enterprise.Instead, the development community of entrepreneurs, philanthropists, and foundations has the challenge to develop a standard methodology. We’re excited to see the momentum and collective steps that organizations and individuals are collectively taking, especially as the Acumen Fund declared yesterday the WMD (World Metrics Day)!

At VillageReach, we are evaluating different methodologies to formulate our approach to quantify and present the value of a social investment. We are considering two methods: a BACO Calculation (for best available charitable option – created by the Acumen Fund) and an SROI calculation. The BACO model enables us to perform a cost-effective analysis on philanthropic dollars by comparing two options: a charity donation vs. an investment in a business. This analysis provides us with decision-making data to assess and determine the return the greatest social impact at lowest cost. The SROI (“social return on investment”) methodology has been in development for many years, and calculated using a discounted cash flow analysis + projected socio-economic contributions (direct, demonstrable cost savings and revenue contribution that are associated with the social purpose enterprise) into a projected blended business performance. There are distinct challenges with both of these approaches as it is difficult to often find a “comparable” charity donation and quantify the context of social outcomes. However, we strive to build quantifiable metrics that will help continuously evaluate our investments and allow us to communicate our impact to an external audience. Let us know what steps you are taking or thoughts about this process as this is clearly a shared effort.

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06.11 2009

We all know that operation of any health center requires a variety of external inputs- energy, transport/logistics (delivery services), and communications systems to name a few. In wealthy countries, these services would normally be provided by the commercial sector. In focusing efforts on the “last mile,” however, any and all of these commercial services are simply not available or are so expensive to procure that they are not operationally viable.

At VillageReach we focus on energy, transport/logistics and communications, the “Enabling Services” that are required to fulfill the mission of VillageReach programs. When implementing health care programs in regions with weak or nonexistent Enabling Services, NGO’s have traditionally elected to handle the provisioning of Enabling Services internally. Trucking in generators, fuel and other supplies directly supports the program objectives but it does little to provide Enabling Services to the surrounding community. It is widely recognized that a successful and sustainable program intervention creates and uses local capacity. The VillageReach model and programs to date have as a guiding principle the creation of local capacity not only for last mile health care infrastructure but also for the Enabling Services that support that infrastructure.

To sustain the improvement in health and decrease in mortality that is the core of the VillageReach mission it is necessary to create permanent health care resources in last mile communities. Sustainability requires that Enabling Services be available, be reliable and can be procured at affordable rates for the long term. In order for Enabling Services to be available for the long term the customer base must be substantially larger than just the rural health care clinic and therefore must include a vibrant market in the local community. The lack of Enabling Services in many of these rural situations clearly shows that sufficient market demand does not exist today for a viable commercial business. It’s a classic chicken and egg problem – VillageReach is moving forward as a catalyst with creating basic demand for Enabling Services as part of its programs to support last mile health care and incubating the required commercial business for the services.

So, why is social enterprise required in the VillageReach model? Because without established Enabling Services as one of the key elements in the intervention – the VillageReach programs would not achieve the required sustainability and would become yet another solution that fails to provide the long term impact when transitioned to local operation.

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06.08 2009

So who is paying attention to medical distribution systems and more specifically to the innovation pile-up we highlighted in the last post?

There are 4 main categories of players: Governments, NGOs, multi-lateral organizations (WHO, UNICEF) and public-private alliances.  While there are many, many important and interesting stakeholders in the field, the most interesting evolution over the last decade has been the ways these groups cross boundaries to find creative ways to work together.

When Global Alliance for Vaccines and Immunization (GAVI) was established in 2000, it had an enormous impact on the field of vaccines.  GAVI refocused attention on vaccine-preventable diseases which waned in the 90’s after the highly successful immunization campaigns of the 70’s and 80’s. gavi-logoAnd as a public-private partnership funded by donor governments and private organizations such as the Bill & Melinda Gates Foundation, it brought serious financial resources to the table (over $2 billion of net assets in 2007).  Currently, GAVI supports 72 low and middle-income countries in vaccine financing and procuring.  While considerable resources at GAVI have been directed towards augmenting the supply of existing vaccines and developing new vaccines, GAVI and its stakeholders are increasingly beginning to consider the inadequacies of the health systems into which these vaccines must enter.

One particularly interesting initiative is The Optimize Project, a joint collaboration between the WHO and PATH.  The Optimize Project seeks to identify and advocate for the “immunization systems and technologies for tomorrow.”  Funded by the Gates Foundation, the Optimize Project is a recognition that discovery and development of vaccines is only half the battle.

Here at VillageReach, it has been exciting to see the development of enthusiastic recognition and articulation of the problems of logistics at theLast Mile.

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06.05 2009

Welcome to the VillageReach blog! This blog follows VillageReach’s progress as well as interesting ideas, projects and events at the intersection of health with social enterprise, technology & logistics.

We ’re launching with our thoughts on the “Innovation Pile-up.” Chris Elias, the Executive Director of PATH, coined this phrase to describe the coming challenge facing public health systems around the world as years of medical research and development, particularly for vaccines, come to fruition.

When VillageReach started working in Mozambique in 2001, we found there was no system for distributing medical supplies beyond the provincial level … a situation that’s unfortunately the norm in most developing countries.

The Mozambique system was chaotic and under-resourced in 2001. Since then, the world has begun to invest heavily in new medical products, such as vaccines, to address the huge disease burden affecting developing countries. Governments, international organizations, and private charities have spent trillions of dollars in research and development of new products. But new opportunities bring new challenges. The new vaccines just starting to become available are much more expensive and are physically, much larger.

For example, polio is a basic vaccine administered around the world today. Twenty doses of polio fit in a vial about the size of your little finger. At 13 cents per dose, the vial is worth only a few dollars. A twenty-dose, polio vial doesn’t take up much room in the refrigerator, and if the distribution system ruins a few vials, or has a few leaks in it, then the loss is not huge.

In contrast, one new vaccine to prevent rotavirus, a stomach bacteria that kills thousands of children every year, costs $5 and is the size of your fist. The HPV cervical cancer vaccine is expected to be priced between $50 and $100 per dose in developing countries. The malaria and HIV vaccines, which we hope are coming soon, are also likely to be very expensive. Current distribution systems are overwhelmed now; the new products will swamp them.

Unless we invest in improving the ability of developing countries to handle these new products, trillions of dollars of investment will be wasted and, more importantly, children in those countries will once again, be passed by. While we can get excited about new product developments, and rightly so, we can’t forget that our job is not done, until drops are in mouths, and needles are in arms.

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