Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Funding

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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07.05 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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05.06 2016

Reposted from the Bill and Melinda Gates Foundation Blog: Impatient Optimists 5.6.2016

I recently returned from a week in Mozambique with a goal of learning about new immunization supply chain models and observing their impact.  I also wanted to better understand opportunities and constraints for taking this work to scale — in Mozambique and across other Gavi-eligible countries.

In 2013, the Gates Foundation began working with five provincial governments in Mozambique, the national ministry of health, and VillageReach on a new system for delivering vaccines.  The new system represented big changes over their current design.  It takes a holistic approach – reconfiguring the transport system, re-assigning roles and responsibilities of personnel, obtaining and using data differently, and integrating supervision and cold chain maintenance into monthly vaccine distributions. I was able to get a first-hand view and see some impressive results of this “next-generation” system while in southern Mozambique’s Gaza Province. In Gaza, there’s now a much better chance that when children show up at a health center for immunizations, the vaccines will actually be there.  Vaccine stockouts have dropped from 43% in 2012, before the province revamped their system, to routinely less than 3% today.

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04.25 2016
immunization supply chain in Mozambique
Dr. Ramos Mboane

Summary: Dr. Ramos Mboane, Provincial Chief Medical Officer in Mozambique shares insights on key factors countries should prioritize to make #vaccineswork.

 This post is part of the #ProtectingKids story roundup. Read all the stories here

During World Immunization Week, people from all over the world are talking about one thing: how do we reach more children with the vaccines that they need? As someone responsible for overseeing the immunization program in my province, this is an issue I think about every day.  We all know that there are many reasons children fail to get immunized, and when I think about closing the immunization gap – in Niassa, and for other communities like us around the world – these are the things I think are most important:

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02.22 2016

I was thrilled to witness President Nyusi launch the rotavirus vaccine in Mozambique last fall. Tens of thousands of little Mozambicans will be spared severe dehydration, even death, due to rotavirus-induced diarrhea – if the vaccine reaches them. And herein lies the problem.  When a vaccine sits in a national or district warehouse, a truck, or a broken “fridge,” it cannot save lives. 

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11.12 2015

Republished from the UN Foundation Blog: Global Connections

I often find myself playing the global health version of “if you were trapped on a desert island, which three things would you bring?” In my version, it’s “if you were the Ministry of Health, which three programs would you fund?” When I do this thought experiment, I often run into the exact same impossible questions cash-strapped ministries of health are forced to answer: Do I fund health workers or do I buy medicines? Do I fund treatment services or invest in preventative health programs? What will have the most impact? What will save the most lives? After a while, I do what any reasonable person faced with an unwinnable game does – I find a loophole.

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11.23 2013

We are proud to be featured again this year in SIF’s annual Global Giving Guide. See our profile exerpted below, and visit the Seattle International Foundation.

Rose is a Group Village Head in central Malawi and is responsible for overseeing the well-being of a community of a 32-village community. She has long been concerned with the challenges women and children face in her community when trying to access health information and services. Women and children in Rose’s villages, and in Malawi as a whole, experience high rates of maternal and child mortality as a result of limited health care and lack of reliable information on safe motherhood and child health practices.

Today, women and children in Rose’s community are getting help from Chipatala cha pa Foni (health center hotline, in English), a toll-free maternal and health hotline that provides health information, advice and referrals. Service users also have the option of signing up for weekly voice or text messages to receive health tips & reminders to access preventive health care services. Village volunteers help women understand and use the service and ensure access for those without cellphones through project phones.

Chipatala cha pa Foni effectively extends the reach of the health system, allowing women and children to access health services from their home without having to travel long distances to the nearest health center. As a mother, grandmother and community leader, Rose has been a strong advocate for use of the Chipatala cha pa Foni in her community. Rose encourages those who have cell phones to lend them to those who cannot afford one, and has even contributed her own phone to those who don’t own phones. As a result, the Chipatala cha pa Foni program has had a vast reach into the community, receiving over 11,000 calls and registering nearly 6,000 women and caregivers of young children for the tips and reminders service.

Since 2000, VillageReach has worked to improve the performance of health systems, serving more than 10 million people in remote communities across sub-Saharan Africa.

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06.18 2013

Today we’re excited to announce the Bill and Melinda Gates Foundation is awarding VillageReach a grant to improve vaccine delivery in Mozambique. The two-year Final 20 Project targets more than 400 of the Mozambique Ministry of Health’s rural health centers that serve a population of approximately 13 million. See our press release announcement and this blog that is also featured at Impatient Optimists.

Who are the Final 20 and Why do we Need to Reach Them?

Today, more than 80 percent of children around the world receive a complete routine of life-saving vaccines during their first year of life. That is a significant increase from the 17 percent coverage 30 years ago, giving millions of children each year a better chance of seeing their first birthday. This increase in coverage is the result of decades of hard work to establish immunization systems in countries where previously, they simply did not exist.

Despite this huge success, these immunization systems have reached their maximum capacity. A considerable gap remains in reaching the final 20 percent–the children who are the hardest to reach, and the ones currently not served by existing immunization programs.

These children usually live in remote, rural communities, several miles from a health facility with little transport available, in villages that can’t be reached by large delivery vehicles, beyond the reach of cell phones, and where electricity is available only sporadically, if at all. In these communities, vaccine coverage rates are very low and child mortality unacceptably high because weak underlying infrastructure limits the potential of what the health system can deliver.

To reach this final 20 percent–24 million children–with the current group of life-saving vaccines, not to mention the exciting new vaccines that are just being introduced, it’s time to apply new innovative approaches and delivery models.

Increased attention is now being directed to this challenge. As part of a broad strategy by the Bill & Melinda Gates Foundation to improve vaccine supply chains, VillageReach is working to scale new system innovations to improve vaccine distribution across Mozambique.

The Final 20 Project is building a sustainable model of innovative supply chain design, enhanced data collection and reporting, and public-private partnerships to improve the underlying infrastructure the health system requires. Our goal is to provide tools, research and evidence that will benefit Mozambique and other countries as they work to improve their immunization systems to accommodate the new vaccines and improve the health of their children.

The Final 20 Project is an extension of a model we have applied in Mozambique for over ten years, while working with provincial government health departments (DPS) to streamline their logistics system. The ad hoc collection-based approach, where frontline health workers must leave their health posts every month to collect vaccines and related supplies from their district office, was replaced by a dedicated distribution system (Dedicated Logistics System or DLS) with a small number of specialized government workers visiting the health centers monthly to deliver vaccines and supplies, repair equipment, collect data, and provide supportive supervision.

The project incorporates an electronic logistics management information system that enables more practical and reliable data collection. This system allows the DPS to improve the monitoring of commodity availability at the health facility level and delivery components in order to improve the flow of vaccines through the supply chain and reduce shortages of stock even in the hardest to reach areas. With more regular data being reported, administrators are now able to see what is happening and make informed management decisions to improve system performance.

VillageReach also leverages the private sector to supply critical infrastructure services, such as communications, energy and transport, that are critical for both the health system and the private sector.

For example, one of the barriers to a functioning cold chain for vaccine distribution in the remote northern provinces is a lack of fuel to power vaccine refrigerators in regions far from the electrical grid. In response we established an energy services company, VidaGas, in partnership with a local organization, to provide propane gas to the health centers.

Since its establishment in 2002, the company has grown significantly to become the largest independent energy services supplier in northern Mozambique. The revenues VidaGas gains from selling to non-health sectors help sustain the company and support its obligations to the health system. With propane-based refrigeration now being replaced by new, more efficient solar and passive refrigeration technologies, in the Final 20 Project, we will work with the private sector, DPS, and other partners to support this transition, as well as, continue to develop creative private sector-based solutions to fill gaps in infrastructure needed to support vaccine distribution.

These are just a few examples of system innovations to improve vaccine distribution in Mozambique. We are excited to be a part of these and other efforts to extend the availability of life-saving vaccines to all children around the world.

Now is the time to reach that final 20 percent.

Allen Wilcox

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07.19 2012

We recently sent out this latest update … here’s our news in case you missed it …


  • update on our work to improve maternal and newborn health in Kwitanda
  • the latest on our Chipatala Cha Pa Foni (health center by phone) program, part of the Innovations for Maternal, Newborn and Child Health initiative
  • Mozambique

  • new update to our Mozambique Dedicated Logistics System (DLS) program
  • collaboration with the William Davidson Institute (University of Michigan) Supply chain & logistics study: new research to quantify the logistics challenges for a variety of medical commodities
  • Dr. Seth Berkley, President of the Global Alliance for Vaccines and Immunization (GAVI) visited the DLS program
  • Technology Initiatives

  • ODK Scan: update on our collaboration with the University of Washington’s Computer Science & Engineering to improve the quality of data collection
  • OpenLMIS: new website with updated details on activities and partners
  • Social Enterprise

  • VidaGas: our collaboration with the ghdLABs program at MIT, to evaluate the marketplace for our social enterprise in Mozambique
  • New Additions to Our Team


  • George Chinkwita – Project Officer, Kwitanada Economic Development Initiative
  • Erin Larsen-Cooper – Program Associate
  • Mozambique:

  • Antonio Gaspar Tomboloco – Field Officer, Niassa Province
  • See here for details …

    Updated Financial Report

  • our recently posted 2011 independent financial audit
  • We welcome your questions and comments,

    Allen Wilcox

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    11.23 2011

    In 2012, we expect to increase the number of our initiatives, adding to existing programs that are continuing from 2011. Financial support goes to helping us further develop our expertise in improving access to quality healthcare for remote, underserved communities by investing in research and development, collaborating with new partners, and conducting programs.

    VillageReach’s initiatives are funded by a combination of individual donations, foundations, and similarly focused technical organizations in the global health community. All of our supporters share a common goal: to improve the capacity of health systems in developing countries in order to serve the millions of underserved.

    In 2012, VillageReach’s goal is to raise $950,000 to support a total organizational budget of $3.16M. Contributions we receive will enable us to continue achieving impact in our current programs, and help us develop additional expertise and expand our work into new programmatic initiatives. Contributions received will be applied across our various initiatives, covering both direct and indirect costs.

    Following is a summary of the scope and support of these initiatives. If you prefer to download this update, visit here.


    Malawi: Community-Level Health System Strengthening Program
    2012 Budget: $408,000

    VillageReach has been working at the district level in Malawi since 2008 to improve the health of children less than five years of age by decreasing childhood illness and mortality in the southern region of Malawi. The focus of the program is to strengthen the health system at the community and health center levels by supporting community health workers, implementing cost-effective interventions to reduce malaria and diarrheal diseases, supporting immunization and other preventative health programs, implementing community-based treatment programs, and improving communication between community health workers and health centers. The majority of this program is supported by a single anonymous funder, who provided initial support in 2008 and has continued supporting the program in subsequent years. For more information on this program, visit here.

    Malawi: ICT to Improve Health Services for Mothers and Children Program
    2012 Budget: $450,000

    We are entering the second year of a multi-year program to increase access to maternal, newborn and child health (MNCH) services by developing an integrated set of information and communications services. The program includes a toll‐free case management hotline for maternal and child health advice and referral, and uses mobile phones to send personalized voice and SMS health messages to women regarding their pregnancy and the health needs of their children. VillageReach is also working with the ministry of health to test a facility‐based scheduling system for antenatal and postnatal care in order to reduce wait times and improve health center readiness for maternal and neonatal health. This project is supported primarily through an agreement with an international nongovernmental organization. For more information on this program, visit here.

    Mozambique: Dedicated Logistics System Program
    2012 Budget*: $1,400,000

    VillageReach is engaged in a multi-year program to improve the performance of the health system in Mozambique, focusing on rural communities that represent over 60% of the country’s population. The program, started in January 2010 and run in partnership with the Mozambique Ministry of Health (MISAU), aims to reduce vaccine preventable diseases and improve health system performance by implementing dedicated distribution channels for vaccines and other medical commodities to community health centers. The program is expected to cover eight of ten provinces, with more than 12 million people served. The focus of the program in 2012 is in achieving results for four provinces. Opportunities for expanding into additional provinces will be evaluated in mid-2012. The program is supported by both individual donations and private foundations. For more on this program, visit here.

    (Note: this program is expected to extend to 2014 at a minimum. The current estimated program budget is $5.6M, with a current funding gap of $3.05M.)


    VillageReach seeks opportunities to improve its technical capabilities and capacity to strengthen health systems in order to improve the health for rural, underserved communities.

    mScan Project: Digitizing Paper‐Based Data Via Mobile Image Technologies
    2012 Budget: $105,000

    We are working with the University of Washington Computer Science and Engineering Department to develop and test mScan, an android-based mobile phone application. The research is evaluating the potential to automate and make more efficient the collection of data in low‐resource field environments by digitizing paper‐based data into usable information via low‐cost, image‐based, mobile technologies. The project leverages the growing supply of lower‐cost smartphones to bridge the gap between the mHealth movement, focused on digitizing all content, and the current paper‐based systems that prevail in low‐income countries. Members of the research team recently spent two weeks in Mozambique testing the new application in the field with our Mozambique DLS program. See here for further details on this initiative.

    OpenLMIS: Logistics Management Information System Initiative
    2012 Budget: $305,000

    This is the first year of a two-year initiative to improve the quality and level of collaboration in developing of information technology for health systems, specifically the logistics management information systems (LMIS) that collect and report data on the performance of distribution networks for health systems. OpenLMIS is a community-lead initiative dedicated to furthering collaboration and development of logistics management information systems to support improvements in health system supply chains in low-income countries around the world. The majority of the project is supported by a grant from the Rockefeller Foundation. For more information on this initiative, visit the OpenLMIS website.

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