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Category Archives: Notes from the Field

01.13 2014

A frontline perspective of the CCPF “Health Center by Phone” Program

When I trained as a midwife, I had no idea that I would be helping deliver babies over the phone. Technology has come a long way, especially in the district of Balaka in Malawi.

In September of this year, Mercy, a 24 year old pregnant woman from Dailesi village in Balaka, told her family that she wasn’t feeling well, and set out for Kalembo Health Center seated on the back of a bicycle driven by her neighbor.

Dailesi village is 12 km away from the nearest health center, and is located in a hilly area far from paved roads. The only transport available is by foot, by bicycle taxi, or–in case of emergency–by ox cart or bicycle ambulance.

After an hour of traveling, Mercy started feeling intense muscle contractions signaling the birth of her baby and could no longer sit on the back of the bicycle. Mercy asked the bicycle driver to stop in a nearby village so that the women living there could help her deliver her baby.

With no other transport available, still far from the health center, and without any skilled personnel nearby to help with Mercy’s delivery, her neighbor decided to call Chipatala cha pa Foni for assistance.

Chipatala cha pa Foni (CCPF), which translates to “health center by phone,” is a toll-free hotline that women in rural Malawi can call to speak directly with a hotline worker for information on pregnancy, newborn and child health, and reproductive health issues such as family planning. A VillageReach project, CCPF provides clients with advice they can follow at home, or refers them to a health center or hospital if they’re displaying “danger signs” which require further care. Women in the community can also sign up for CCPF’s “Tips and Reminders” mobile messaging service to receive regular text or voice messages tailored to their week of pregnancy or their child’s age.

Besides information and referrals, CCPF has also linked key services to the community, as in the case of transport. After visiting the CCPF Hotline Room, the Balaka District Transport Officer was so impressed with the potential of CCPF to save lives that he offered to assist in arranging transport logistics for callers in critical condition or in need of immediate care. He gave us his telephone number and requested that we let him know of any emergency transport needs.

Less than one week later, we took him up on his offer when Mercy called the hotline.

Rose Nkupsya, a nurse and CCPF hotline worker, answered the call from Mercy. Rose understood the urgency of the situation and informed the transport officer. He immediately responded by sending the district ambulance to pick up Mercy and bring her to the nearest health facility.

Before the ambulance could reach her, Mercy delivered a baby boy. Mercy was bleeding heavily when the ambulance arrived and needed to be helped by health workers. But she was afraid of being reprimanded by them for delivering her baby outside of a facility and was concerned that the nurses would not admit her. Over the phone, Rose reassured her, and Mercy agreed to go to the health center where the nurse on duty was able to stabilize her condition and successfully stop the bleeding. Had it not been for CCPF and the transport officer, Mercy would have suffered severe bleeding and infection. Fortunately, she and her baby boy received timely and appropriate care, and both are happy and healthy today.

Chipatala cha pa Foni provides an important service to women in four districts of Malawi, but our work is far from finished. I look forward to continuing to help women have safe pregnancies and deliveries and for children to grow up happy and healthy.

Learn More About CCPF

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06.18 2013

Today we’re excited to announce the Bill and Melinda Gates Foundation is awarding VillageReach a grant to improve vaccine delivery in Mozambique. The two-year Final 20 Project targets more than 400 of the Mozambique Ministry of Health’s rural health centers that serve a population of approximately 13 million. See our press release announcement and this blog that is also featured at Impatient Optimists.

Who are the Final 20 and Why do we Need to Reach Them?

Today, more than 80 percent of children around the world receive a complete routine of life-saving vaccines during their first year of life. That is a significant increase from the 17 percent coverage 30 years ago, giving millions of children each year a better chance of seeing their first birthday. This increase in coverage is the result of decades of hard work to establish immunization systems in countries where previously, they simply did not exist.

Despite this huge success, these immunization systems have reached their maximum capacity. A considerable gap remains in reaching the final 20 percent–the children who are the hardest to reach, and the ones currently not served by existing immunization programs.

These children usually live in remote, rural communities, several miles from a health facility with little transport available, in villages that can’t be reached by large delivery vehicles, beyond the reach of cell phones, and where electricity is available only sporadically, if at all. In these communities, vaccine coverage rates are very low and child mortality unacceptably high because weak underlying infrastructure limits the potential of what the health system can deliver.

To reach this final 20 percent–24 million children–with the current group of life-saving vaccines, not to mention the exciting new vaccines that are just being introduced, it’s time to apply new innovative approaches and delivery models.

Increased attention is now being directed to this challenge. As part of a broad strategy by the Bill & Melinda Gates Foundation to improve vaccine supply chains, VillageReach is working to scale new system innovations to improve vaccine distribution across Mozambique.

The Final 20 Project is building a sustainable model of innovative supply chain design, enhanced data collection and reporting, and public-private partnerships to improve the underlying infrastructure the health system requires. Our goal is to provide tools, research and evidence that will benefit Mozambique and other countries as they work to improve their immunization systems to accommodate the new vaccines and improve the health of their children.

The Final 20 Project is an extension of a model we have applied in Mozambique for over ten years, while working with provincial government health departments (DPS) to streamline their logistics system. The ad hoc collection-based approach, where frontline health workers must leave their health posts every month to collect vaccines and related supplies from their district office, was replaced by a dedicated distribution system (Dedicated Logistics System or DLS) with a small number of specialized government workers visiting the health centers monthly to deliver vaccines and supplies, repair equipment, collect data, and provide supportive supervision.

The project incorporates an electronic logistics management information system that enables more practical and reliable data collection. This system allows the DPS to improve the monitoring of commodity availability at the health facility level and delivery components in order to improve the flow of vaccines through the supply chain and reduce shortages of stock even in the hardest to reach areas. With more regular data being reported, administrators are now able to see what is happening and make informed management decisions to improve system performance.

VillageReach also leverages the private sector to supply critical infrastructure services, such as communications, energy and transport, that are critical for both the health system and the private sector.

For example, one of the barriers to a functioning cold chain for vaccine distribution in the remote northern provinces is a lack of fuel to power vaccine refrigerators in regions far from the electrical grid. In response we established an energy services company, VidaGas, in partnership with a local organization, to provide propane gas to the health centers.

Since its establishment in 2002, the company has grown significantly to become the largest independent energy services supplier in northern Mozambique. The revenues VidaGas gains from selling to non-health sectors help sustain the company and support its obligations to the health system. With propane-based refrigeration now being replaced by new, more efficient solar and passive refrigeration technologies, in the Final 20 Project, we will work with the private sector, DPS, and other partners to support this transition, as well as, continue to develop creative private sector-based solutions to fill gaps in infrastructure needed to support vaccine distribution.

These are just a few examples of system innovations to improve vaccine distribution in Mozambique. We are excited to be a part of these and other efforts to extend the availability of life-saving vaccines to all children around the world.

Now is the time to reach that final 20 percent.

Allen Wilcox

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06.18 2013

The Mozambique Dedicated Logistics System (DLS) Performance Reports are regularly issued, government-approved updates on the status of key performance indicators monitored by the DLS which serve as a gauge of quality system implementation. The first of these reports for publication is featured here.

The performance reports present and explain trends across the following indicators:

  • Health centers visited and data reported – Health centers visited refers to the percent of health centers visited out of all health centers in the provinces operating the DLS. The percent of health centers that are consistently visited is measured by the percent of health centers visited within a 33-delivery interval. Data reported refers to the percent of all health centers reporting data through the DLS logistics management information system, vrMIS.
  • Full delivery of vaccines – This refers to the percent of health centers visited who have received a full supply of vaccines. This indicator is broken down by specific vaccine type. The information system currently tracks all vaccines used in the public health system including BCG, measles, tetanus, pentavalent, polio, and pneumococcal.
  • Stock-outs by vaccine – A stock-out means that there is no remaining dose of any one vaccine at the health facility. The Reports monitor the percent of health centers visited that have experienced a stock-out of a specific vaccine type.
  • Functioning refrigerators – The percent of refrigerators at all health centers visited that are operating at the optimal 2-8˚C temperature range required by all vaccines in Mozambique’s supply chain.
  • Vaccines used – The number of supplies used in the previous month by all health centers visited.

VillageReach, in partnership with Mozambique’s Ministry of Health also aim to produce information on the overall impact of the DLS. However the measurement of impact indicators such as improved immunization coverage and improved community trust in and use of health services are not covered by these Performance Reports since such information requires point-in-time surveys and evaluations conducted over a longer time frame (i.e. every three years). VillageReach’s intention is to issue these Reports every six months, however the schedule of release of the reports will always be subject to partner review and approval prior to sharing.

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06.18 2013

VillageReach, in partnership with the Malawi Ministry of Health, Malawi College of Health Sciences and University of Washington Global Medicines Programs is supporting a two year Pharmacy Assistant certificate course. The College has enrolled fifty students for the 2013 intake. The project is envisaged to address three main factors that affect overall medical supply chain performance namely; human resources, access to information, and availability and use of commodities. Once trained, the pharmacy assistants will be placed at health centers throughout Malawi where currently no pharmacy trained personnel exist.

In February and March 2013, I was part of a team comprised of staff from VillageReach, Ministry of Health and Malawi College of Health Sciences to conduct an assessment in 12 of the country’s 28 districts that will receive students for practicum from May this year. The purpose of our assessment was to collect district level baseline information and identify gaps and strengths on the part of district pharmacies and the Pharmacy Technicians who will be serving as preceptors to the students.

Overall, we found that all the practicum sites have experienced human resources, systems and infrastructure to serve as quality learning sites. However, challenges also exist.

In terms of human resources for instance, our team found that Pharmacy Technician posts are established in all the districts we visited; on average two per district, however the actual filled posts ranged from one to four pharmacy technicians. We also found volunteer pharmacists in two districts.

One of the key challenges that our team noted was that of storage space. This is contributing to disorderly organization of commodities; in some cases our team noted that commodities were stored in several different buildings or locations making it difficult to control inventory.

We also observed delays in submitting district reports, poor record keeping, and general disorganization of data and records in a majority of districts.

Our team also noted that dispensing was not being done by pharmacy personnel. Instead, Hospital Attendants with no training in pharmacy were responsible for dispensing medicines and providing counseling to patients. An additional challenge noted at dispensaries included late openings due to daily pre packing of commodities into individual dosages.

The deliberately enhanced practicum dimension of the pharmacy assistant program design serves several beneficial purposes to both the students’ academic and professional growth, as well as contributing to improved service delivery at practicum sites. Under the supervision of pharmacy technicians, the students will be getting an on the ground practical perspective into their chosen career at practicum sites including experiencing working in rural areas. This setting also presents an opportunity for students to translate classwork and theory into practice, ultimately enriching their academic stance in the training. While supervision and mentoring of the students will be an additional workload on the Pharmacy Technicians, their presence is envisaged to contribute positively to improved service delivery specifically on information management and storeroom management given pharmacy trained staff shortages. This design ultimately prepares the students to hit the ground running with hands on experience upon graduation and deployment to serve in remote health centers where at the moment have no pharmacy trained staff exist.

Charles Matemba
Monitoring & Evaluation Officer

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04.22 2013

Pneumonia is the world’s number one killer of children under five. The World Health Organization (WHO) estimates more than 500,000 children die each year from pneumococcal infection. Mozambique took a big step in fighting pneumonia with the April 10 introduction of the pneumococcal vaccine (PCV).
PCV Launch

This new vaccine requires a strong supply chain with very active monitoring as the vials are distributed. It’s commonly known that vaccines will spoil when exposed to too much heat, but this vaccine is also very sensitive to freezing. As a result it’s particularly important that PCV be kept between 2 – 8 degrees Celsius at all times. PCV LaunchIn a country with 60% of health centers off the electrical grid and very hot temperatures, this is no small challenge. Vials for PCV are also significantly larger than for existing vaccines in Mozambique. The increased size places demands on the infrastructure that is used for storage and transport. Finally, the vaccine is more than 35 times more expensive than any other vaccine dose. In a resource constrained environment, this means that it is crucially important to vaccinate as many children as possible without wasting any vaccines.

PCV LaunchVillageReach is working to support the health system to address these new demands on the vaccine supply chain. In partnership with the government, our vaccine distribution system redesign is reaching more than 400 health centers every month in four of ten of the country’s provinces. Getting the vaccines all the way to the health centers is critical to make sure that all children throughout the country can access this lifesaving vaccine. This vaccine introduction has raised the stakes in Mozambique and for VillageReach – our work has become even more important and the potential of our impact even greater.

Leah Hasselback
Country Director, Mozambique

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04.19 2013

Last week, Patrick Phiri, Senior Technical Advisor, and I had the pleasure of meeting the first cohort of students enrolled in the Pharmacy Assistant TraineesPharmacy Assistants Program training course at the Malawi College of Health Sciences. This group of 50 talented and eager students will be the first trained pharmacy personnel to work in rural public health facilities throughout Malawi. These 50 students were selected from more than 1,200 applicants. Patrick and I were very happy to congratulate the students on their achievement so far and wish them success as they begin their studies.

In Malawi, health facilities and the communities they serve often suffer from a lack of life-saving medicines, primarily due to weak supply chain management systems, poor pharmaceutical management, a lack of data on medical consumption, and inadequately trained personnel. VillageReach, in partnership with the Malawi Ministry of Health, the Malawi College of Health Sciences (MCHS) and the University of Washington Global Medicines Program, is working to accelerate progress towards addressing these key barriers to medicines availability at the facility and district levels by implementing a new approach to the training, deployment, and support of an enhanced Pharmacy Assistant cadre.

As part of a two-year certificate training program, these 50 students will spend ten weeks on campus receiving an orientation in pharmaceutics, pharmacology, and medicines and medical supplies management. After ten weeks, half of the students will be deployed to 12 district hospital pharmacies to begin five months of on-the-job training under the mentorship of Pharmacy Technicians while the other half will remain on campus to continue their classroom learning. After the initial five months, the students will switch places. In their second year of studies, the students will continue with the same schedule only instead of district hospitals, the students will be placed at rural health facilities. As a result, the students will be contributing to improving pharmacy management and supply chain needs at district hospitals beginning in their first year, and at rural health facilities in their second year of studies.

Once these students graduate, they will nearly double the existing pharmaceutical work force in the public health system. According to the 2011 Health Sector Strategic Plan (HSSP), there are only five pharmacists in the country’s public health sector to fill an estimated 90 positions and only 24% of the established positions for pharmacy technicians are filled, leaving clinical and frontline health workers responsible for managing pharmacies and logistics duties. Despite the fact that the vast majority of medical commodities inventoried in rural health facilities’ dispensaries are prescription-level medicines within the United States context, the pharmacy positions are not staffed by qualified pharmacists or pharmacy technicians or other experienced staff. Instead, guards, attendants or other community members with no formal training are responsible for this critical work. The demand for pharmaceutical services, particularly with the advent of the HIV/AIDS epidemic, has increased markedly and points to the need for a comprehensive and sustainable scale-up of the pharmaceutical workforce in Malawi.

The Malawi MoH established a target to train and deploy at least 650 Pharmacy Assistants to enable every health facility in the country to have trained pharmacy personnel on staff. These first 50 students mark the beginning of a large effort in Malawi to improve medicines and medical supplies management in the country. We expect that at this time next year, we will be meeting the next 100 students enrolled in the program. For now, we are thrilled to meet these 50 committed individuals and wish them the best of luck in their studies. We look forward to seeing their success in both the classroom and in their work as Pharmacy Assistants.

Jessica Crawford
Program Manager
Health Systems Group

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11.19 2012

In 2012, the Kwitanda Community Health Project expanded into new programmatic areas, increasing its reach by developing new maternal and newborn health activities, establishing the Kwitanda Economic Development Initiative and starting work on filling gaps in HIV care in the community.

As we start a new fiscal year, the Kwitanda Community Health Project team has reviewed the results from our 2012 evaluation. The full report is posted on the Evaluations and Assessments section here. The evaluation has been a key tool for us in reflecting on last year’s progress and areas that need improvement as well as developing strategies for next year. Here are some of the highlights from this year’s evaluation and examples of how we are using these results to inform our planning:

Access to clean drinking water significantly increased in 2011 and 2012.
During the past year, VillageReach constructed and repaired 10 boreholes to increase access to clean drinking water. Eighty-eight percent of Kwitanda residents have access to clean water and 54% have to travel less than 500 meters (< 1/3 mile) to the nearest water-source. We will continue working to improve access to clean drinking water over the next year. Access to sanitation improved between 2011 and 2012. Over the last year, VillageReach supported the installation of 220 sanplats in household latrines to improve sanitation and helped construct 1,045 tippy-taps to provide hand-washing facilities and decrease diarrhea. As a result, we saw an increase in the number of household with sanitary latrines (up to 80% from 72% in 2011) and the number of households with access to a handwashing facility (up to 43% from 14% in 2011). Next year, VillageReach plans to intensify our efforts in information, education and communication around safe water storage and handwashing and improving sanitation through implementation of community led total sanitation (CLTS). CLTS ensures that every household has a pit-latrine (and uses it) and aims to have the catchment area declared Open Defecation Free (ODF).

Malaria rates decreased significantly between 2011 and 2012. Of the households included in our sample survey, 62% reported at least one person with malaria during the last 4 months, compared to 72% last year. Though malaria rates decreased, there was a disappointing decrease in mosquito net ownership and usage. Approximately 1/3 of children who received a mosquito net from VillageReach last year reported not sleeping under a net this year. VillageReach plans to conduct follow-up with a sample of families in order to learn more about what barriers prevent these children from sleeping under a net despite receiving a net in addition to continuing with net distribution to children aged less than five years.

Baseline indicators for maternal and neonatal health highlight a need for new interventions. The maternal and neonatal health indicators from 2012 suggest gaps in current services geared toward mothers and young children, particularly in the area of facility births, exclusive breastfeeding, receiving timely postnatal care, and receiving all four recommended antenatal visits. VillageReach is well positioned to address these gaps next year and has already started addressing these gaps; VillageReach recently supported the training of all 23 Health Surveillance Assistants for Kwitanda in maternal and child health and launched outreach antenatal clinics to better serve women hard-to-reach areas. VillageReach also intends to support chiefs in establishing village models that aim to foster maternal, child health and safe motherhood programs including IEC on the importance of male involvement in maternal and safe motherhood.

We are excited about the upcoming year and look forward to intensifying our efforts to reduce malaria and diarrhea as well as expanding our reach into new areas.

Patrick Karonga Phiri
Project Manager, Kwitanda Community Health Project
Balaka, Malawi

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07.10 2012

In Malawi, more than eight in every one thousand women die from maternity-related causes, while almost 90 percent of childhood deaths occur during the first year of life. Malawi women have a 1 in 36 chance of dying during childbirth. Reducing the maternal mortality rate in Malawi not only saves the lives of women, but most maternal interventions will also reduce mortality and morbidity among infants. Moreover, saving the life of a mother can protect older children; orphaned children have a three to ten times greater risk of death than those with living parents.
In October and November 2011, VillageReach conducted a needs assessment to identify the barriers to optimal maternal and neonatal healthcare in Kwitanda, Malawi through interviews and focus group discussions with health workers, health surveillance assistants (HSAs) and women in the community. The results pointed to the major barriers to optimal maternal and child healthcare as long distance to the health facility and lack of transportation for antenatal care (ANC), delivery and post-natal care, perceptions of poor treatment and safety at hospitals compared to delivering with Traditional Birth Attendants, traditional beliefs maternal and infant health practices and when and where to access care, and a general lack of knowledge regarding the importance of early post-natal care.
To overcome these barriers, VillageReach is implementing the following programs:

Extend the Reach of ANC services to the community Currently, ANC services are offered at Kwitanda Health Center but women have expressed a great interest in these services being provided closer to home. We will leverage existing structures to conduct ANC outreach clinics by Kwitanda Health Center staff closer the community. ANC outreach is scheduled to begin this month.

Train Additional HSAs in Maternal and Neonatal Health With funding from The Seattle International Foundation, VillageReach will train and support additional HSAs in maternal and neonatal health to extend the cadre available to visit women in their homes. Currently, five HSAs in the Kwitanda catchment are trained in MNH. The specialized cadre of HSAs can provide home-based postnatal care to all newborns, track the health status of pregnant women, encourage ANC visits and facility-based delivery, and support women in the development of a birth plan. Nine HSAs are currently in training.

Leverage Existing Maternal and Neonatal Health Services Provided by VillageReach VillageReach’s work with MNH through the Chipatala Cha Pa Foni (health center by phone) case-management hotline service was rolled out in the Kwitanda area in March. The hotline provides health advice and information to pregnant women and caregivers of children under-5, refers individuals to a health center or village clinic if warranted, and registers women and caregivers for an automated tips and reminders service sent to their phones or accessible through phones of community volunteers. The hotline provides direct access to a health worker for community members who may have previously had a poor perception. Thus, in addition to providing direct advice, the hotline serves to improve community trust in the health system.

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06.07 2012

I spent a couple of weeks in Mozambique recently to review our energy services social enterprise, VidaGas, that provides much-needed propane to hundreds of rural health centers throughout the north of the country. VillageReach owns the for-profit business in partnership with Oasis Fund and FDC.

I was joined by two MBAs, Alexandra Fallon and Deborah Hsieh, from MIT’s Sloan School of Management who are enrolled in an intriguing course. ghdLABs, developed by Anjali Sastry, is focused on assessing opportunities to improve healthcare delivery through changes in management, engineering and systems. See here and here for background on the course, which includes links to blogs from Deborah and Alexandra about their experiences. The students have been assisting with our plans to help build a longer business outlook for VidaGas and also to measure the social benefit the company provides. Both efforts will be important in helping attract additional capital for the company in the coming years as it continues to grow and further support the public health system.

Energy Improves Health

When VillageReach first started its work to improve the last mile of delivery capacity in Mozambique’s Ministry of Health, we realized a critical gap in energy supply was affecting the performance and economics of the cold chain, and in turn limiting the ministry of health’s ability to store and distribute vaccines. VidaGas was established to address this lack of reliable energy supply.

Since its founding in 2002, the company has progressively expanded its operations to serve more and more health centers and communities. In the past two years, the growth rate has accelerated, due in part to a critical investment made by Oasis Fund.

The additional capital enabled VidaGas to step beyond its presence in Cabo Delgado Province in the northeast and establish additional filling and storage facilities, greatly increasing the addressable market for propane sales. By the 4th quarter of this year, VidaGas will be operating in all four northern provinces from an operational base of three filling plants in the cities of Pemba, Nampula, and its newest facility in Mocuba. More on Mocuba below.

Operating VidaGas as a business instead of a charity addresses the critical requirement for a sustainable supply of energy for the health system. The majority of Mozambique’s population in the north resides in remote villages with no electricity and little access to transport and communications services. Health centers in these communities need a reliable supply of energy for refrigeration, lighting and sterilization in order to provide even basic medical care.

To ensure its service to the health system is sustainable, VidaGas supports this social mission by selling gas to a variety of enterprise customers: restaurants, hotels, small factories, plus a growing retail network and several urban hospitals. VidaGas Sector Share of RevenueHere’s the share of sales across these categories for 2011 – rural health centers represent only 17%. The message is that without the private sector revenues, the company would not have the resources to support its obligations to the health system.

VidaGas’ social benefit isn’t limited to the benefit it provides to the ministry of health. Other government ministries use propane for their facilities and a growing number of households are buying the gas for cooking, reducing the use of charcoal and wood that produce harmful indoor pollutants. Reductions in biomass consumption also contribute to limiting the rate of deforestation.

What’s Next

pic We’ve been at this effort since 2002. As VidaGas sales have grown, so has its reputation as a reliable supplier to the ministry of health and other customers. In 2011, VidaGas shipped more than 350 tons of propane, an increase of 35% over 2010. Now the business has identified the opportunity to supply health centers in the province of Zambezia. In April, VidaGas broke ground on a new facility in Mocuba City in central Zambezia, see this image on the right. Once the facility is completed in August, Mocuba will have the same 21-ton storage capacity as the Nampula facility you see below. With a population of nearly 4 million and more than 300 rural health centers across Zambezia Province, pic1we anticipate both strong demand and see an important opportunity to assist the health system. In 2012 we expect sales to increase at a significantly higher growth rate than the year before.

Beyond the rural health center network VidaGas supports today are many more health centers that suffer from unreliable energy supply. To expand its social impact, VidaGas must scale further: in the future the company will require additional capital in order to invest in new facilities, equipment and personnel.

Attracting investors is inevitably a challenge, even as the social enterprise industry matures and encourages more socially conscious investors. Our work with MIT will help support VidaGas’ future growth, helping us prepare a more robust strategic outlook for the company and producing an evaluation of anticipated financial and social returns for investors. As this review progresses, we’ll write more on our views of VidaGas, so look for additional reports on the company’s milestones and prospects for the future.

John Beale
Director, Strategic Development &
Group Lead, Social Business Group

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12.09 2010

In the previous post, Nick shared the exciting news that data from health centers in Mozambique is now available for us to see. Living in an environment where information is easily available at our fingertips, we often take the availability of data like this for granted. In reality, obtaining data from a place where information systems and health records aren’t commonly used is quite challenging!

Yet, the information is crucial not only because it can strengthen the overall performance of the health system by enabling data-driven decision making by our partners on the ground, it is necessary in order to measure progress and impact. And as I’ve written previously, VillageReach is committed to monitoring and evaluating the progress and impact of the Dedicated Logistics System in Mozambique.

The key questions to ask when attempting to evaluate impact are whether or not the Dedicated Logistics System has met its objectives to improve health system performance and increase immunization coverage. In the baseline evaluation, we attempt to answer questions such as: how many children are immunized and how often do health centers run out of vaccines. Unfortunately, this type of information is just not available. There are no immunization registries to search. Health centers don’t keep patient records. Even if they did, we still wouldn’t be able to know how many children are not immunized because there are no vital record systems either. These things just aren’t tracked.

In order to get the information we believe is valuable to answer these questions, we went out and collected it. In order to estimate the immunization coverage, we conducted more than 800 household surveys in randomly selected villages across the two provinces of Cabo Delgado and Niassa. The sample size gives us enough statistical power to make an estimate of the true immunization coverage rate with 95% confidence and because the villages were randomly selected, the sample is representative of the population. In each household, we essentially asked whether or not the children living there had received certain vaccines. In addition, we conducted surveys in more than 60 health centers in those villages to get an idea of how the health centers were performing. We worked with a group in Mozambique who hired and trained local staff to conduct the surveys and complete the data entry. The process took about nine months from the time we first sought Ministry of Health approval for the study until we started seeing the data.

Despite a few challenges along the way including delays in schedules with field teams, traveling time to remote villages, and correcting for concerns with the data such as missing entries and incorrectly completed surveys completed, we have real numbers. We have real data from the very last mile. Finally, we can use this data to answer our questions regarding how many kids aren’t being reached by vaccination services and what we can do to improve this. Using this information, we can tailor our program activities in ways that can make the biggest impact and that is what we intend to do.

Before we can share the results publically, we need approval from the Ministry of Health. We’ve started the process and have already shared the results with provincial leaders in Cabo Delgado and Niassa. We will be presenting the results to the Ministry later this month or early next year. We are looking forward to sharing our results with you as soon as possible. Stay tuned.

Jessica Crawford
Program Associate

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