VillageReach has worked with the community and governmental partners to transform the vaccine supply chain in Mozambique, increasing access to vaccines at the last mile.
Improving Immunization Supply Chains in Mozambique
International vaccine coverage rates hover around 80% and 1.5 million children still die from vaccine preventable diseases. While vaccines and other medical commodities are widely available, delivering vaccines and reaching the final 20% of children in many countries is still a significant and complex challenge. Key decision makers do not have data visibility to accurately forecast and respond, transport issues prevent reliable deliveries, and health workers struggle to adequately deliver care given the immense demands placed on them.
Improving reliable access to vaccines under these constraints requires a system-wide approach in order to achieve long-term, sustainable impact. VillageReach worked closely with community and governmental partners in Mozambique to redesign the vaccine supply chain model. The results of these changes demonstrate how supply chain improvements made together as part of a system design approach can significantly increase vaccine availability at the last mile.
A new supply chain design introduced new efficiencies to Mozambique’s vaccine supply chain resulting in
- significant increases in fully vaccinated children
- dramatic reduction in stock-outs, and
- reduced government operating costs
Video: Skoll Foundation profile of VillageReach in Mozambique
Scaling the Innovation
The new system currently reaches more than 900 health centers serving a population of over 18 million.
VillageReach currently provides technical assistance to provincial ministry of health authorities to support implementations and operations of the new system in 8 out of 11 provinces as well as implementation of new strategies for continuous improvement and supply chain management.
The key components of the system are:
- A simplified, streamlined distribution process involving re-assignment of tasks, level jumping and optimized delivery routes
- An open source information management system, OpenLMIS (locally referred to as SELV) provides real time data for more accurate data collection and utilization
- The introduction of a Field Coordinator role; a specialized worker who delivers vaccines and supplies, repairs equipment, collects and reports data, and provides active and ongoing supportive supervision and training, allowing frontline health workers to focus on patient care
See how key elements of this approach differ from the typical multi-tier approach, and the impact of these changes on vaccine availability and cost:
Learn More:
- Supply Chain Design
- Lessons Learned in Reaching the Final 20: Building a Next-Generation Immunization Supply Chain in Mozambique
- LIÇÕES APRENDIDAS EM ALCANÇAR O PROJECTO FINAL 20
- MOH: A Time for Change
- The Role of System Design for Improved Immunization Supply Chains
- The Importance of Peer-To-Peer Learning
- Dr. Ramos Mboane, Perspective from Mozambique
- Final 20 Policy Paper Series: Financial Flows, Change Leadership, System Design, Human Resources, Cold Chain, Data for Management
Impact
An independent impact evaluation and complementary costing study revealed the following results of the Dedicated Logistics System (DLS) as compared to a controlled province:
- DPT-HepB3 vaccine coverage rates increased from 68.9% to 95.4% for children age 24-35 months.
- All other vaccines had similar increases resulting in an average coverage rate of 92.8%.
- The reported monthly incidence of stock outs in rural health centers decreased from 80% to 1%.
- Up-time of the cold chain increased from approximately 40% before the project to 96% over a year after the conclusion of the project.
- The DLS model was 17% more cost-effective, at $5.03 per child fully vaccinated with DPT-HepB3 compared to $6.07 per child vaccinated in Niassa where VillageReach was not engaged.
- The DLS system was also 21% less expensive per vaccine dose delivered: $1.18 per dose delivered vs. $1.50 per dose delivered.
From the Field
Now, the patients come every day, because they know that they will find vaccines.
I don’t have to worry about going to collect vaccines, now they bring enough quantities.
VillageReach’s innovative approach to vaccine distribution formed the basis for the 2013 Gates Vaccine Innovation Award given to Margarida Matsinhe, VillageReach Field Officer in Mozambique. In 2014, Margarida was also named by Melinda Gates as one of nine world-wide leaders who are “changing the vaccine game.”
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