Last week was an important week for Mozambique’s vaccine program. Dr. Seth Berkley, President of the Global Alliance for Vaccines and Immunization (GAVI) and former VillageReach Board Member visited Mozambique. Seth’s participation on our board was critical in supporting and advising VillageReach in the early days so it was an honor to meet him in Mozambique and share what we’ve learned and how far we’ve come. His visit was an opportunity to reflect on progress that VillageReach has made.
I had the pleasure of accompanying the team from GAVI on a visit to a district hospital, rural health center, and a mobile clinic in a rural village. Together we observed the successes and challenges in the vaccine system. We experienced the long distances, difficult roads, lack of transportation available, overwhelming amount of patients, and insufficient health center infrastructure. Being in those rural settings with this global team, I was reminded of the value of the VillageReach approach of looking at all these challenges from a last mile point of view.
There are two ways of looking at the problem of how to get vaccines and supplies to a large number of difficult to reach health centers. The first way is to think about what it takes to make the planned distribution work – what resources are required to make sure that the provinces and districts have the transportation, budgets, staff, and training required? The other way to look at the problem is to look from the health center up – given the existing constraints, how can the system be made to work? The VillageReach perspective is the latter. With minimal investments in the supply chain, we are improving the distribution of vaccines, decreasing stock outs of vaccines, and improving performance of vaccine services. Bringing the global level to rural Mozambique was a reminder of the validity of that approach, and how it’s applicability is relevant the world over.
Having spent almost 7 years working at VillageReach, it was a true pleasure to think back to the early days and see how far we’ve come in Mozambique. We started in 2002 with a pilot project, then evaluated that project to show increased impact and cost-effectiveness of a logistics system redesign. That was followed by 1 ½ years of advocating with the government to change policy, when we reached a major milestone in November 2009 as the Minister authorized each of Mozambique’s 10 provinces to implement our Dedicated Logistics System. We’ve now been supporting four provinces to implement the Dedicated Logistics System for 1 ½ years, and we’ve learned a lot.
We’ve learned that advocating for logistics system design change is a big challenge with global and national policy support for decentralization. Even when the status quo isn’t the best option, change is always hard. There are incentives in any system to maintain that system. We’ve faced those challenges head on and leveraged the incentives to change systems to achieve greater impact. We’ve also faced challenges with the erratic nature of public sector funding, and worked to find solutions to the problems to enable support to a routine vaccine distribution system. We’ve learned a lot about introducing and implementing change, and we continue to learn.
Leah Hasselback
Mozambique Country Director