Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Notes from the Field

04.07 2015

Improving Data for Management of the Vaccine Cold Chain in Mozambique

Last week I was spending a lot of time with my colleague from UNICEF/Mozambique to create a distribution plan for  new cold chain equipment procured and funded by UNICEF. This is a great opportunity for the country to strengthen the cold chain to ensure vaccines are available and potent all the way to the last mile of delivery.

Read full story
03.16 2015

March’s arrival has brought a much-needed return to many of the essential services in northern Mozambique that the public health system and communities alike depend on.  In early January we reported on the devastating loss of both electricity and transport due to severe flooding throughout the region, including many of the communities we work with in neighboring Malawi.  

Read full story
02.18 2015

Have you ever forgotten about a doctor appointment? Or put off scheduling an appointment because you didn’t have the time? With all the schedules and activities we juggle today, missing or forgetting to schedule appointments is common. Often, we put off making an appointment until we feel sick or are in pain. Waiting to go to the doctor until something urgent happens becomes particularly dangerous for pregnant women when routine antenatal care (ANC) is critical for both the health of the baby and the mother. In Malawi, where maternal and child mortality rates are some of the highest in the world, increasing ANC can be integral to improving maternal, infant, and child health, yet routine ANC is not a common practice. Increasing knowledge and awareness about the importance of ANC is a key component to improving maternal and child outcomes.

Read full story
02.09 2015

VillageReach, in collaboration with D-tree, is proud to announce the implementation of a new mHealth application in Malawi. What an exciting partnership! During the first week of February 2015, 25 health surveillance assistants (HSAs), nurses and other health workers in Balaka District received intensive training on smartphone technology and the capabilities of a new maternal and neonatal health (MNH) assessment application developed by D-tree. Using smartphones to improve the assessment of pregnant women and their children will increase access to health care and improve the quality of care provided in rural villages.

Read full story
01.22 2015

VillageReach operates several programs in the areas affected by the recent flooding in Malawi including the Kwitanda Community Health Project, located in Balaka District. VillageReach’s ongoing work in Kwitanda highlights the critical role of infrastructure and how systemic improvements are critical to community health outcomes, especially when disaster hits.

Read full story
01.20 2015


This week, our blog, Thoughts from the Last Mile is dedicated to our staff who live and work in Malawi and Mozambique where devastating flooding this past week has greatly intensified the existing barriers to healthcare delivery brought on by a lack of infrastructure-energy, roads, communications, etc.  While aid is available, the inability to get aid to those in need remains a significant challenge. This critical lack of access is the basis on which VillageReach was created.

Read full story
01.08 2015

Why Peer-to-Peer Learning is a Critical Part of Health System Improvement

As the Country Director for VillageReach in Mozambique, I am very encouraged by the progress we have made in the last 12 months. Great strides were made at the national level to bring attention to the need for supply chain system optimization based on the achievements of the Dedicated Logistics System (DLS). Peer-to-peer learning played a key role in that progress.

Read full story
10.10 2014

I am a clinician by profession, serving a population of over 30, 000 in the 25 villages that my health center serves. I am the only clinician at the health facility with a single nurse to assist covering when possible.  We recently lost the only health surveillance assistant that was trained as a drug clerk as she has left to pursue a one and a half year course in midwifery. This leaves me as the only clinician and also the only person to manage stocks in the medicine store (pharmacy).  I undertake the majority of dispensing responsibilities as the hospital attendants that sometimes need to fill this role are not knowledgeable about medicines. When it’s month end, I am also responsible for doing the physical inventory and producing a monthly report.  Each of these tasks requires time away from my primary responsibility of treating patients. This results in less time with patients, and inadequate reporting of essential information required to manage inventory. For example, I am not sure the reports that I send are even a true representation of the situation on the ground due to the limited time I have to devote to this task.

Read full story
02.10 2014

SaitiBy Saiti Chikwapulo

I believe the work of VillageReach has saved lives.  Our work, supported by generous donors, has changed the way an entire community has approached health and healthcare services by providing access to safe water, improvement of hygiene practices, and high uptake of healthcare services –leading to a healthier and more productive community.

Before VillageReach, Kwitanda was facing quite a number of health challenges as many Malawi communities face; cholera and other diarrhea diseases were common. Many people were getting sick, contributing to an unproductive and unhealthy community.

A major contributing factor to the reduction of these diseases was the implementation of Community-Led Total Sanitation (CLTS) approaches. Previous approaches to human waste disposal in our community were not working because they were not affordable or sustainable. By figuring out ways that the community could lead the effort, rather than depend on, or wait for others to do it, we created sustainable change.

By figuring out ways that the community could lead the effort, rather than depend on, or wait for others to do it, we created sustainable change.

A modification of the CLTS approach called School Led Total Sanitation focused on improving sanitation facilities in schools, coupled with a hygiene education programme in the belief that the children are change agents in their communities to enforce and enhance adoption of the community initiative. In this case, the Kwitanda schools have been instrumental in this community-lead process, working with VillageReach to ensure adequate numbers of toilets and washing facilities are available at all schools.  Every school now has a management committee and Parent Teacher Association (PTA).  These school-based structures are modes of delivering adequate sanitation facilities in schools. Their main purpose is to mobilize communities to take these issues on, with VillageReach encouraging, supporting and advising as needed. The schools and the PTA raised their own funds and organized all of the required labor to build adequate toilet facilities.  The community now has a sense of ownership and pride in being able to provide and maintain healthy sanitation systems for their own schools.

These two approaches have improved sanitation facility availability, use and adoption of positive protective hygiene practices, thereby contributing to fighting cholera and other hygiene-related diseases in Malawi.

Education and promotion of healthy standards and hygiene practices, like providing a tight-fitting pitlatrine drop-hole cover and hand washing facilities, has also contributed to the elimination of Cholera and other illnesses.  Through outreach and education efforts lead by VillageReach, every house has access to health messages and information promoting health and hygiene.

VillageReach has also played a very important role in reducing illness by increasing access to a reliable source for clean water.   Kwitanda is in a low lying area with many streams of water flowing, especially during the rainy season.  We have a lot of pools of water and water pollution is common. People would often drink from these contaminated water sources by drinking from unprotected dug wells, one of the primary ways cholera is transmitted.  VillageReach broke that cycle of transmission by drilling boreholes (40 meter holes with pumps) in order to improve access to protected water sources. In addition, our team worked with the community leaders and health center to greatly improve the supply and protection of drinking water in the home by making available and promote use of chlorine solution, commonly used to kill water-based or water-washed disease-causing pathogens.  This is especially critical during the rainy season, when the rate of transmission is highest. Before VillageReach intervened, availability of chlorine solution was not consistent, stock outs were common, lowering community trust in the supply and decreased use in homes. Applying the VillageReach model, starting at the last mile, working from the end of the supply chain up, greatly improved availability and use. People began to trust the system more knowing that product would be available at their local Health Center when they needed it, and this greatly increased usage in homes.

A report from the Ministry of Health Malawi reports that no Cholera cases were reported in 2013! Read the story here. 

As Cholera has been a major public health concern in Malawi, this is great progress.

If we can make such significant changes in one community of Kwitanda, imagine what could happen if we apply this model on a larger scale?

For more information on our Kwitanda Health Project


Read full story

Search Blog:

Newsletter Sign Up

By providing your email address you agree to receive periodic email news from VillageReach.

Support Health Care for All

Your tax deductible contribution helps to increase health care availability to reach the most under-reached.

Donate Today

Malawi healthcare worker