After more than four years’ experience of managing the vaccine supply chain in the Equateur province of northwestern Democratic Republic of Congo (DRC), it is high time for us to consider the lessons we have learned in optimizing the distribution of health products to achieve universal health coverage. In the context of limited resources, a solution combining direct product distribution, formative supervision and the use of data for nimble decision-making is the best option to improve the equitable availability of health products and access to services in remote and hard-to-reach communities.
Hard-to-reach health centers
Equateur province has a hard-to-reach population, scattered throughout the equatorial forest, straddling the majestic Congo River and its numerous tributaries. In addition, poor road infrastructure, lack of systemic communication and a scarcity of logistics providers make product distribution very difficult. As a result, these remote communities have insufficient access to quality health products and services. How have we improved the availability of health products in these challenging settings?
Improving access to primary health care
Two solutions are being used to increase access to health care and the data has shown the impact of availability of vaccines and essential medicines to hard-to-reach communities.
The Next Generation Supply Chain (NGCA) initiative
Since July 2017, VillageReach and the Provincial Government of Equateur, with funding from the World Bank, GAVI, and the Bill & Melinda Gates Foundation, has implemented NGCA to optimize the health commodity supply chain through direct distribution coupled with professional supervision and the collection of critical logistical data. NGCA reduces total supply chain costs by 34%, according to the financial study conducted in February 2018 by Professor Noël of Harvard University and VillageReach.
Direct and integrated distribution improves the availability of health care products, including vaccines and essential medicines at the last mile. No stock outs were observed for all six of the antigens analyzed between July 2017 and June 2018 in the three health zones (HZs) targeted by NGCA. Prior to the program, these three zones had experienced sixteen stockouts during the period from January to June 2017, according to Acasus analyses from DVD-MT Equateur.
In early 2022, in collaboration with Ministry of Health (MoH) officials, organized a trip to remote and hard-to-reach health areas in the health zones of Bikoro, Ingende, Lilanga Bobangi, Lolanga Mampoko, Mankanza, Ntondo, and Bolenge.
This mission was used to perform many activities including:
- To conduct the direct distribution of health products
- To perform the formative supervision – that is the evaluation and training – of health workers and health zone management teams
- To collect data for the forthcoming performance study on the use of medical delivery drones
- To complete curative maintenance of a TCW 40 SDD solar refrigerator in the Bondo Health Center
Thanks to the pooling of resources, the following results were achieved with great efficiency:
- The availability of vaccines has been improved to 80% in the 62 health facilities visited.
- More than 124 health care providers have been trained on the management of health information and preventive maintenance.
- The TCW 40 SDD solar refrigerator that had been broken down for more than two years has been repaired.
Transport of health products by drones
To strengthen distribution to hard-to-reach areas of the Equateur province, VillageReach, in partnership with the DRC MoH, and Swoop Aero, is using the world’s largest drone network to provide two-way transport of health products, such as vaccines, essential medicines, infectious disease sample collection, protective equipment, National Health Information System (SNIS) reports and more.
Mid-term performance results from a study conducted by the Kinshasa School of Public Health (ESPK) in June 2021, showed that the availability of vaccines in health centers served by drones improved from 78% to 102% in five months, and the average delivery time went from two days to less than two hours. Health workers at remote health centers saved two days of travel per month thanks to drones, allowing them to spend more time with patients.
Lessons learned from transforming health care delivery
During the implementation of these two solutions, we’ve observed four key lessons to optimize direct health product distribution in difficult-to-access settings:
Lesson 1 – Pooling Resources
Regardless of the source of funding, pooling financial resources allows donors to share the often-high costs of distribution required to overcome geographic, road and communication infrastructure challenges.
In addition, sharing terms of reference with all stakeholders and integrating multi-skilled provincial and zonal managers who can provide formative supervision and active data collection for decision-making makes a distribution mission more cost-effective.
Lesson 2 – Integrated Distribution
Integrated distributions of health products more efficiently and effectively meet the needs of hard-to-reach communities. During the COVID-19 pandemic, our motorized dugout/vehicle convoys, as well as Swoop Aero’s drones, transported a variety of commodities such as vaccines, essential generic drugs, protective equipment, contraceptives, and more.
Lesson 3 – Distribution at Any Opportunity
Routine or emergency, the quantities of products to be requested or delivered to any opportunity are guided by the max-min inventory control parameters which are: average monthly consumption, review period, minimum and maximum stock levels.
Capitalizing on every opportunity to travel to remote and difficult-to-access settings to ensure delivery of health products is the best way to improve access to care.
Lesson 4 – Appropriate Use of Drones
Depending on the circumstances and characteristics of the products to be transported, the choice of aerial technology to supply landlocked healthcare facilities is crucial for a prompt response. Drones are more appropriate in the emergency delivery or collection of health products due to their speed. During the November 2021 yellow fever vaccination campaign in the Bikoro Health Zone, drones delivered vaccines daily and collected reports in the Lake Tumba Islets. Similarly, the transport of heat-sensitive, small-volume products on a routine basis is easier with drones.
Where health centers are remote and under-reached communities can’t access health products in regions of Equateur, scaling up NGCA and Drones for Health solutions have already made a difference in transforming health care delivery, as can be seen in the data and the four lessons we’ve learned since embarking on this health product distribution journey.
About the author: Archimède BOFAMBU MAKAYA, Drone Program Manager at VillageReach is a medical doctor at the University of Lubumbashi in DRC. Dr. Archimède has more than twelve years of experience in the Ministry of Public Health, Hygiene and Prevention, where he served as Medical Director of the CSR of Kalamba, Medical Chief of Staff HGR Lukolela, Medical Chief of Health Zone of Lukolela and Provincial Multipurpose Supervisor. He then worked as a VillageReach consultant and provincial coordinator before becoming the Drone Program Manager in DRC. He has great experience in primary health care, the supply chain of health products and treatment of infectious diseases in remote areas.