Point of care starts at the primary health center, where the patient and the health care worker meet. But for many communities in Inhambane Province, in the south of Mozambique, that point of care is harder to reach than for other Mozambicans. This is because Inhambane has the highest number of villages outside of a 60-minute radius from the nearest health center. In the past, people from communities across Inhambane province travelled long distances to health centers and endured long wait times for care, sometimes to learn that the medicines they need for treatment were not available. This is no longer the case since the introduction of the Last Mile Supply Chain (LMSC) program.
In 2019, LMSC partnered with private sector transporters to ensure that essential medicines and supplies reached the most remote, hard-to-reach health facilities according to plan, and are available in health facilities as and when requested by the provincial health directorates. What’s more the transition to outsourced transportation for distribution of essential medicines has ensured that health care workers could focus on providing care and dispensing essential medicines, now regularly available in the health facility pharmacy, to their patients.
As a result of LMSC’s partnership with the private sector transporter and the Provincial Health Directorate, the distribution of health products from the Intermediate Warehouse (IW) in Vilanculos to health facilities has been reduced from an average of 30 days to just six, meaning that communities have consistent and timely access to medicines, ultimately improving the quality of care for Inhambane residents.
The road to change
Mozambique’s Central Medical Stores (CMAM) had long empowered provincial supply chain leaders like Ricardo Francisco Munguambe, the IW Manager in Vilankulos, to store, manage and plan all aspects of the logistics of medicines distribution. Not unlike many government entities, this work was done with limited human and financial resources, and often with staff that lacked the required skills to effectively execute the distribution process. Building on lessons learned since the launch of LMSC in 2018 in Zambezia, VillageReach expanded to Inhambane province in July 2020. VillageReach was entrusted to assist with the transport of medicines and other products and Mr. Munguambe began to notice improvements.
“Looking at the route taken [by VillageReach] with the introduction of outsourced transport, I see many differences. In the past, the activity of taking supplies to the last mile depended on ambulances. We could have a well-developed plan but it was not carried out because the vehicle was needed elsewhere,” said Mr. Munguambe.
In July 2020, the IW started working with VillageReach across four of Inhambane’s districts, namely Vilankulo, Inhassoro, Govuro and Mabote, to distribute medicines and other health products to a total of 39 health centers and one rural hospital.
“With VillageReach, we have a different approach: above all, there is a guarantee that things [health products] will arrive on site. At the start, the medicine is checked and upon arrival the delivery note is presented [to ensure nothing is missing]. Another experience is that, in the past, each sector had to make its own request to take products to the last mile, but with VillageReach, they can now join together in a single trip,” Mr. Munguambe added.
Yes, challenges remain, particularly in the district of Mabote where a number of health centers are very distant and can only be accessed via challenging routes, especially in the rainy season when water pools across the roads. Despite these issues, Mr. Munguambe was very pleased with the progress he’s observed, concluding that “[our partnership with VillageReach] is a big gain for the sector. From the learning we have, we feel that the best way would be for other areas to also introduce outsourced transportation.”
Pharmacies always fully stocked
After meeting with Mr. Munguambe, I spoke with more health workers to understand the difference that LMSC has made in their work, including Brigido Munhambane Chauque, Director of the Mapinhane Health Center.
Mr. Chauque told me that “life changed” with the introduction of LMSC. He recounted that in the past he had experienced stock-outs, causing some patients to return home without medicine; it became a distressing event for community members relying on these medicines and for the health care workers like Mr. Chauque who wanted to provide their patients with high-quality medical care.
Because of the transport challenges that Mr. Munguambe mentioned, the Mapinhane Health Center was not given a fixed date for the receipt of medicines and other medical supplies from the IW. Mr. Chauque said, “Now communities are not complaining about delays. And I assure you there is not much to improve. Even the pharmacy staff has not expressed any complaint due to forgetfulness or because of incomplete medicine orders, as they do the confirmation to make sure that everything is compliant.”
Each day, Mapinhane Health Center sees roughly 300 patients, of whom an average of 110 are outpatients, many suffering from malaria and acute respiratory infections. Mr. Chauque feels confident that he will have the medicines, products and resources he needs to care for them.
But what of the communities at the last mile? I visited the Lavane neighborhood to meet with some of Mr. Chauque’s patients.
Anatércia Morais Mangumbule has lived in Lavane, near CS Mapinhane, since 2005. Her daughter Caira was born in March 2021. Of the care she and her daughter have received, Ms. Mangumbule said, “They attended to us well. There is medicine. Everything is fine with me.”
Several other people in the neighbourhood shared the same sentiment with me. It seems that the situation has greatly improved with the introduction of outsourced transport for health products. Communities across Inhambane are feeling the change.
Looking to the future
My final visit was to the Mangunguemete Health Center in Inhassoro District, to speak with Pharmacy Technician Manuela Madureira. As she greets me, I thought of the future of health care in the province.
By the end of September 2021, LMSC had expanded outsourced distribution to 10 of 11 provinces in Mozambique. At this point, USAID CHEGAR – Commodities for Health: Ensuring Guaranteed Access and Reliability took over direct management of outsourced distribution. Having set up the infrastructure to implement collaboration with Government and the private sector, LMSC will now focus on ensuring that CMAM and Provincial Warehouses have the capacity to directly liaise with and provide financial and performance oversight of the private sector transporter.
My meeting with Ms. Madureira was a good reminder of the progress that has been made. “Usually, we receive a message via SMS that vehicle is coming with a delivery. There have not been delays. Whenever we verify that the drug will be delivered, we need not ask for a backup,” She told me.
Inhambane province has seen big changes in the quality and efficiency of their medical supply chain over the past three years. Further progress will require maintaining strong collaborative relationships between public and private sector stakeholders, ensuring that the health care improvements that have been made are sustained now and into the future.