In 2015, VillageReach conducted an assessment of the public health supply chain in two of the most remote and underserved provinces of Democratic Republic of the Congo, the provinces of Equateur and Tshuapa. The results show that the health supply chain is a “casse-tête,” literally, a “head-breaker” – something so complicated and challenging it makes everyone’s head hurt. Equateur Province in particular presents daunting logistic challenges: not only is it isolated, but the “highway” in this region is the mighty Congo River. Medicines must first be transported on a plane or boat from the capital, Kinshasa to the provincial capital, Mbandaka, then another 10 days by boat to reach the zonal health office. From here, medicines are distributed by canoe, motorcycle, bicycle or on foot to the health centers that serve the local communities and sometimes even further, directly to where patients live.
In addition, the limited cell phone coverage (not to mention electricity) outside of Mbandaka creates a headache for health workers struggling to find out if the medicines they need are in stock. With frequent stockouts, it is not uncommon for health workers to make the long journey for supplies only to return empty handed. Downstream, patients have the same experience. Over a third of the population lives more than an hour’s walk from a vaccination center, and a significant portion of the population lives in temporary camps, moving every few months. Getting to a health facility is already a challenge – made even more discouraging when the medicine they need aren’t available when they get there.
Knowing the many challenges in Equateur is not enough to overcome them. In order to develop a realistic, impactful, and sustainable plan to strengthen the supply chain and health system, we must also understand what resources and systems are already in place and working. With this knowledge, we can create a plan that capitalizes on what exists and make strategic investments to fill the gaps. And that’s exactly what we have been doing over the past few months, starting with the vaccine supply chain.
Using Llamasoft’s Supply Chain Guru software, we are building a computerized model of the supply chain including transport modes, existing cold chain equipment, and the human resources on the ground. Then comes the fun part – playing with the model to test out crazy ideas and to “try on” different innovative solutions. Out of these scenarios, we’ll come up with strategies uniquely adapted to the local complexities of Equateur.
The vaccine supply chain does not exist in a vacuum. Alongside the supply chain modeling, we will also conduct a resource mapping and financial modeling exercise to identify what resources are available beyond the existing vaccine supply chain. Where there are gaps that can’t be filled by rearranging existing components, we’ll figure out exactly where we can add resources, people, or money to make the biggest impact. The “we” in all this is not just VillageReach; there are a number of actors who are committed to working together to strengthen vaccine supply chains in Equateur.
- The provincial health authorities already possess possibly the most important resource in improving health systems: open-mindedness and enthusiasm about exploring innovative strategies to make sure that medicines and vaccines get to the people who need them.
- Working with health authority managers and partners outside of the vaccine supply chain enables collaboration and prevents duplication. For example, we hope to explore the possibility of integrated distribution utilizing the relatively robust market for private sector transportation already being used for malaria commodities.
- Partners, including the Red Cross, already have a network of volunteers and community health workers trained in interpersonal communication to promote healthy behavior, including vaccination. Just ensuring that vaccines and medicines are available at health centers isn’t enough; community health workers play a key role in promoting the use of health services.
By the end of the year, the results from these modeling exercises will help define a “Next Generation” supply chain for pilot in Equateur. We will monitor it, strengthen it, and reconfigure anything that’s not working. As we gain a greater understanding of how to capitalize on the resources here in Equateur, we will take those lessons and see how we can scale up beyond the pilot, always focused on continually improving and adapting the model. We will spend the coming months putting our heads together to solve this casse-tête, leading to new and sustainable strategies that will help get vaccines and medicines to even the hardest to reach communities in DRC.