Thoughts from the Last Mile Welcome to the VillageReach Blog

Category Archives: Notes from the Field

04.08 2010

IMG_0669My name is Peter Nakamura and I am one of the newest members of the VillageReach team. I am currently based in Nampula, Mozambique to help coordinate a project funded by USAID to help individual households gain access to propane. The project is coordinated through VillageReach and its social business, VidaGas – the largest distributor of LPG (Liquid Propane Gas) in Northern Mozambique. As the next step in its growth, VidaGas is working to expand its customer base to households in order to diversify its clientele and expand the availability of a cleaner and more efficient source of cooking fuel than charcoal or wood (which are the most common types of cooking fuel in Mozambique).

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In order to increase the demand and awareness of LPG among households, we will be launching a social marketing campaign tailored to the realities on the field. From personal demonstrations of around 10 people to big events where we expect over 200 people to attend, we will be testing different methods to stimulate demand and awareness. In the end, our goal is to be able to learn from this experience and create a social marketing model and toolkit which we will be able to implement in other developing countries and with a variety of product (whether that be bed nets or batteries).

Check in regularly for updates on our progress.

Peter Nakamura, Project Administrator

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12.14 2009

IMG_0669With our focus on last-mile healthcare access for remote rural populations, it may sound like a contradiction to address the pressing challenge of improving access for urban populations.  But in 2010 that’s exactly what we’ll be doing.  In August and September we were in India to look at locations for a new vaccines distribution program, and to facilitate a workshop of local and regional NGOs, UNICEF, the Ministry of Health and Family Welfare (MOHFW), and the corporate sponsor of the program.  One of our site visits included a trip to one of Mumbai’s largest slums, built right on top of the city’s main garbage dump.

The workshop highlighted inadequacies of the cold chain in addressing the government’s immunization goals, critical gaps in energy, communications, and transportation infrastructure that exist for many last mile communities; and that health workers are overburdened due to the scope and scale of their day-to-day work.  Not surprisingly, our experiences in sub-Saharan Africa are addressing these same issues.

How did we get from rural to urban?  As part of the workshop we included discussions on India’s population growth and industrial development that is leaving millions behind in rural communities throughout the country.   The three states of Bihar, Madhya Pradesh and Uttar Pradesh make up over 50% of the country’s estimated 10 million unimmunized children.  That’s the largest unprotected population of any one country on the globe. The great majority of theses states’ children are the very rural poor.   But two of these states also have the highest child mortality rates for urban poor communities in the country, which highlights the correlation between the rural poor and the rapid urbanization of the country, as desperate migrating families look for employment.  Dr. Siddharth Agarwal of the Urban Health Resource Centre, based in Dehli, is a passionate and persuasive advocate for these urban slum communities.

Not unlike remote rural communities, urban slum populations are difficult to reach.  There is weak physical infrastructure, limited reliable health services and poor documentation of the populations.

IMG_0660The plight of India’s city slum dwellers certainly isn’t a new topic … Mumbai’s Dharavi Slum of “Slumdog Millionaire” fame helped ensure that, but that the task of improving last mile healthcare access for the urban underserved is strikingly similar to that of rural communities, certainly may be.

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10.09 2009

CIMG4849A few weeks ago I traveled to Malawi to work on two projects that use SMS phone technology. One of these projects focuses on providing community health workers (CHW) with an easier and quicker way to communicate with their local hospital, supervisors, and fellow community health workers. I spent an afternoon with 18 of the 21 CHWs in the Kwitanda province to understand how they would utilize such technology, and used that information to develop use cases (e.g. outbreaks, inventory shortages, emergencies, etc.) that will help them provide better health care to villagers in their catchment areas. For the other project, I met with shop owners, assessed the medicines they sell, and discussed the benefits of inventory management with them (which is of personal interest to a supply chain person like myself). The insights I gained through interacting with CHWs and shop owners were then funneled to our technology team, which is working on our upcoming Management Information System (vrMIS3).

I am excited about the potential that these two projects will have for those working in rural and remote areas with poor road and electricity infrastructure and for us, who will be able to collect real-time information about what the needs are in the field and how we can develop programs and innovative approaches to strengthen health systems at the last mile.

Although my time in Malawi was quite busy, I was glad to have had the chance to visit an under-5 clinic, where large numbers of women brought their children to be weighed (for growth monitoring purposes) and to be immunized. In Malawi, like in most of the world, women spend their days collecting water and firewood, washing clothes, caring for handfuls of children, tending to their fields, and preparing meals. Yet these women were willing to put their other duties on hold so that their children could receive vaccines and have a chance at growing up healthy. The health workers in Kwitanda have done a great job at educating these women about the importance of vaccines and health care for their children.CIMG4923

-Jessica, Logistics Manager

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07.14 2009

Back in February, VillageReach purchased bicycle ambulances for a number of communities in rural Malawi.  Before they had these bicycles, community members would often resort to making homemade stretchers to carry their loved ones to the nearest health facility.  Needless to say, the communities are very excited to have the new bicycle ambulances.  In June, I was able to go back to Malawi and visit three of the communities with the new ambulances.

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Welcomed by song and dance, I was incredibly excited to learn that the communities had formed committees to maintain the bicycleambulances and regulate their usage.  The committees each had an appointed treasurer who gathered and secured funds to ensure that thebicycle ambulances would be well kept as a community resource.  Of the three communities I visited, one community had used their bicycleambulance twice, another once, and the third had still not used theirs.  While at first this seems like the bicycle ambulances are being underutilized, to me it reflected a real valuing of the bicycle ambulances;the communities were not allowing them to be abused and were reserving them for truly grave emergencies.   This was a perfect (and heartening) example of real community buy-in, which at the end of the day is one of the few variables that can really support true sustainability.

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Malawi healthcare worker