I am proud to announce that last month a team composed of provincial government and VillageReach staff successfully conducted the first direct distribution of vaccines and family planning commodities in the Equateur Province of the Democratic Republic of Congo. Under the Next Generation Supply Chain Initiative, this constitutes a major milestone worth celebrating. It represents more than a year of planning and advocacy to engage government leaders and partners (UNICEF, ECC CORDAID, SANRU, OMS, and Croix Rouge) to take bold steps toward change to ensure more reliable delivery of vaccines and other essential health commodities to “the last mile”, often the most remote and hard-to-reach communities in DRC.Read full story
At the 2017 African Union Summit, Heads of State endorsed the Addis Declaration on Immunization, which demonstrates convincing political support to improve equitable access to vaccines. Now countries must embrace the hard work required to deliver immunizations and other health commodities to all citizens. Only when governments lead with a strong vision, supported by donors and non-governmental organizations (NGOs) in a collaborative effort, will large-scale impact be achievable. In places like the Democratic Republic of Congo (DRC), new approaches are bringing the government together with these groups – and seeing greater collaboration between donors in support of government efforts.
Leaders in the DRC have committed to overhauling the country’s dozens of supply chains, developing a highly-functioning, efficient system capable of reaching even the most remote populations. The terrain and sheer size of the DRC make this uniquely challenging. Health officials recognize that traditional supply chain models are not sufficient, and are actively seeking new approaches. But they cannot do it alone. VillageReach is one of many organizations supporting the government’s quest to develop, test, implement and scale strategies that can improve this essential mechanism for providing healthcare.Read full story
The annual Global Health Supply Chain Summit brings together supply chain professionals from all over the globe to discuss and share important trends in global health and the supply chains that support global health efforts. Last year, the big ideas from the event reinforced critical components of our work to improve health supply chains: public-private partnerships, system design, and data for management.
This year’s summit provided another great opportunity for VillageReach and our ministry partners to share our experiences, to learn from others, and to identify important trends shaping the global health supply chain community. The VillageReach team reflects on some of these trends below.
For the past month, I’ve been in Democratic Republic of Congo working to further establish and expand VillageReach’s presence in the country. I’ve also been preparing for a workshop to present the preliminary results of a supply chain modeling exercise that will help key stakeholders identify opportunities for improvement. In the process, I’ve been making the rounds to all our partners, and a key question about our work keeps coming up:
What is taking so long?!?
While visiting rural health units outside Montepuez district in Mozambique, I met a mother at Naioto clinic. It had taken her two hours to get to the facility, with a baby on her back. She was happy to stand in a queue for vaccines for her baby because vaccines were available. The nurse at the clinic, Ana Bendita Miguel, remembers times when she had to turn these mothers away. Prior to ensuring regular, monthly distribution of the provincial delivery truck, it wasn’t uncommon for Bendita to ride a bus to the district centre, a difficult trip of 68km to collect vaccines. In addition to taking Bendita away from seeing patients at the clinic, the bus fare cost her 240 MZN (around $3.30), which was not refunded. In those days she said, “when I didn’t have money for bus fare, I couldn’t prevent the stockout.”
Transformational change does not always happen overnight. In the case of immunization supply chains (iSC), real transformational change requires iteration. It is a process of continuous improvement: cycles of thinking, testing, and improving to constantly push the system forward. While the final result might be a complete redesign of the end-to-end supply chain, each step along the way is a necessary part of getting to a better model. Sometimes the wheels of change move quickly, when political will is aligned with resources and capacity. Sometimes the wheels move more slowly, during phases of learning and refining new ways of doing things. With any large-scale change, the key is to never stop moving forward.
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.”
At 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.”
The differences between West Africa and Southern Africa are well known, even if partially built on generalizations and stereotypes. There are personality differences, language differences, different foods and ways to eat, different and distinct rhythms heard in discotecas. While regions and individual countries are culturally unique throughout Africa, many share the same challenges and goals when it comes to improving their health systems. A few of these similarities stood out when the Ministry of Health in Mozambique hosted a team from the Ministry of Health in Togo this past week. The Togo team—Dr. Napo-Koura Gado Agarassi, Secretary General of the MoH; Dr. Ayi Hervé D’Almeida, Director of Procurement and Inventory Management; Dr. Amevegbe Kodjo Boko, National EPI Director, MoH, Togo – came to Mozambique to better understand how this country runs its supply chain for health commodities and what lessons can be learned between the two countries.Read full story
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.Read full story