Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: NGO’s

02.10 2017
Dr. Chan and me on the University of Washington Campus

One of the highlights of University of Washington’s symposium celebrating ten years in global health was seeing the Director General of the World Health Organization, Dr. Margaret Chan. Dr. Chan was charming as ever, with a spring in her step and a smile on her face. Perhaps it is because she is nearing the end of her term (her successor will be chosen during the upcoming World Health Assembly) that despite moments of levity, her words had a more sobering ring.

Dr. Chan painted a complex picture of the world in which global health professionals work.  We are confronting new diseases and old diseases, dealing with post-antibiotics and post-truth. She warned the attendees that some believe a long-standing social contract has been broken and “we are now living in a world that has lost its moral compass”. Before we could wallow in our collective struggle, Dr. Chan laid out four priorities to help guide health policies and programs.  Here’s what they mean for our work at VillageReach.

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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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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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11.19 2015

Last week, the annual Global Health Supply Chain Summit took place in Dakar, Senegal, bringing together supply chain specialists and thought leaders from around the world to keep challenging each of us to strive for better performance of supply chains. It is a week to reflect on what is currently happening in supply chain management, and it sets the agenda for priorities for the coming year.

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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
President

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07.19 2012

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

Malawi

  • 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

    Malawi:

  • 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
    President

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    12.09 2010

    In the previous post, Nick shared the exciting news that data from health centers in Mozambique is now available for us to see. Living in an environment where information is easily available at our fingertips, we often take the availability of data like this for granted. In reality, obtaining data from a place where information systems and health records aren’t commonly used is quite challenging!

    Yet, the information is crucial not only because it can strengthen the overall performance of the health system by enabling data-driven decision making by our partners on the ground, it is necessary in order to measure progress and impact. And as I’ve written previously, VillageReach is committed to monitoring and evaluating the progress and impact of the Dedicated Logistics System in Mozambique.

    The key questions to ask when attempting to evaluate impact are whether or not the Dedicated Logistics System has met its objectives to improve health system performance and increase immunization coverage. In the baseline evaluation, we attempt to answer questions such as: how many children are immunized and how often do health centers run out of vaccines. Unfortunately, this type of information is just not available. There are no immunization registries to search. Health centers don’t keep patient records. Even if they did, we still wouldn’t be able to know how many children are not immunized because there are no vital record systems either. These things just aren’t tracked.

    In order to get the information we believe is valuable to answer these questions, we went out and collected it. In order to estimate the immunization coverage, we conducted more than 800 household surveys in randomly selected villages across the two provinces of Cabo Delgado and Niassa. The sample size gives us enough statistical power to make an estimate of the true immunization coverage rate with 95% confidence and because the villages were randomly selected, the sample is representative of the population. In each household, we essentially asked whether or not the children living there had received certain vaccines. In addition, we conducted surveys in more than 60 health centers in those villages to get an idea of how the health centers were performing. We worked with a group in Mozambique who hired and trained local staff to conduct the surveys and complete the data entry. The process took about nine months from the time we first sought Ministry of Health approval for the study until we started seeing the data.

    Despite a few challenges along the way including delays in schedules with field teams, traveling time to remote villages, and correcting for concerns with the data such as missing entries and incorrectly completed surveys completed, we have real numbers. We have real data from the very last mile. Finally, we can use this data to answer our questions regarding how many kids aren’t being reached by vaccination services and what we can do to improve this. Using this information, we can tailor our program activities in ways that can make the biggest impact and that is what we intend to do.

    Before we can share the results publically, we need approval from the Ministry of Health. We’ve started the process and have already shared the results with provincial leaders in Cabo Delgado and Niassa. We will be presenting the results to the Ministry later this month or early next year. We are looking forward to sharing our results with you as soon as possible. Stay tuned.

    Jessica Crawford
    Program Associate
    VillageReach

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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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    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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