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Thoughts from the Last Mile Welcome to the VillageReach Blog

Tag Archives: system design

10.26 2017
Melissa West and Sid Rupani from LLamasoft sharing the use of system design and modeling for supply chain improvement at the TechNet Conference.

Donors and NGOs around the world are investing in technologies that promise to make vaccines available to children everywhere. Many of these innovations took center stage at last week’s TechNet Conference, reflecting the enthusiasm to try something new. But maybe what we need is not necessarily something new – just something different.

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10.12 2017
In DRC, an interactive workshop was used to introduce modeling to Ministry of Health officials.

Through my work optimizing supply chains, I have truly come to realize the importance of looking at “the big picture.” If every detail matters in the effective operation of a supply chain, it is also critical to connect the dots and understand how functions interact. Getting health products to remote health centers is no straightforward endeavor—there are many complex steps and processes involved that can make it difficult to visualize the larger, connected system.

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08.30 2017
The first distribution of the Next Generation Supply Chain Initiative at the Konongo Health Center in DRC.

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.

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02.17 2017

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.

Motorbike on a canoe.
Transport in remote parts of DRC include boats and motorbikes.

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.

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11.28 2016

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.

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11.23 2016

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?!?

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09.20 2016

final-20-report-coverWhile 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.”

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09.15 2016

dscn3648Transformational 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.

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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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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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Malawi healthcare worker