Search our comprehensive archive for detailed documentation of our work including  evaluations, studies, journal articles, publications and more.

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Evaluations and Reports

Pharmacy Assistant Program Year Three Report

February 20, 2016
Pharmacy Assistant Program Year Three Report

Barr Global approved a three-year grant of $1,500,000 to VillageReach to fund the training of at least 150 Pharmacy Assistants (PAs) for health facility deployment to improve pharmaceutical management in rural Malawi. This report provides an update on the progress made during the third year of the three-year grant (from August 2015 to January 2016).

ODK Scan in Malawi Final Field Test Report

December 7, 2015
ODK Scan in Malawi Final Field Test Report (Dec. 2015)

A report of ODK Scan as tested in a field trial in Malawi. The objectives of this first field trial were to determine: 1) usability of the ODK Scan-­‐compatible paper
form by frontline health workers (HSAs); 2) data recognition accuracy; 3) usability of ODK Scan by field
office administrative officers.

Performance Report of the Dedicated Logistics System (2014)

February 27, 2015
Performance Report of the Dedicated Logistics System

This Performance Report provides a summary of the routine metrics for performance of the Dedicated Logistics System
(DLS) for vaccines January-December 2014

District Logistics Capacity Study

April 1, 2013

This report provides findings and recommendations from a study examining the health logistics capacity and performance of 53 districts in Mozambique. The study analyzes quantitative and qualitative evidence obtained through surveys with 114 Pharmacy, PAV (Expanded Programme on Immunization), and Management personnel in health facilities/medicine stores in all health districts across four provinces: Maputo, Gaza, Niassa, and Cabo Delgado. This survey sample represents just under 40% of all districts in Mozambique’s health system.

Pharmacy & Supply Chain Strengthening Program

November 20, 2012
Barr Foundation

Program updates for the three-year Pharmacy & Supply Chain Strengthening Program to improve access to essential medicines.

Journal Articles

Examination of Patient Flow in a Rural Health Center in Malawi

July 25, 2016
BMC Research Notes

Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural
health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries
can treat more patients and improve service quality.

Fostering the use of quasi-experimental designs for evaluating public health interventions: insights from an mHealth project in Malawi

June 10, 2015
African Population Studies Special Edition 2015

The evidence base to support the growing field of mHealth is relatively nascent, with most studies lacking the level of rigor needed to inform scale up of interventions. This paper investigates the impact of a maternal, newborn and child health (MNCH) mHealth project in Malawi, comparing the intention-to-treat (ITT) and the treatment on the treated (TOT) estimates, and discussing the implications for future evaluations. Services offered included a toll-free case management hotline and mobile messaging service for women and children. The evaluation methods included a quasi-experimental pre-test post-test design, consisting of cross-sectional household surveys. A total of 4,230 women were interviewed in the intervention area and 2,463 in the control site. While the intervention did not have any ITT effects of the MNCH outcomes studied, there were large TOT effects. Rigorous evaluation designs can be successfully applied to mHealth pilot projects, helping to understand what works and what does not.

Introducing an enhanced cadre of pharmacy assistants to improve dispensing, management, and availability of medicines at the health centre level in Malawi

December 17, 2014
Journal of Pharmaceutical Policy and Practice

Abstract: VillageReach, in partnership with the Malawi Ministry of Health, the Malawi College of Health Sciences and the University of Washington Global Medicines Program, is addressing key barriers to medicines availability by implementing a new approach to training, deployment, and support of an enhanced pharmacy assistant cadre. Key aspects of the program include curriculum redesign to include more content to enhance skills in supply chain management and an extensive practicum component at public health facilities

Other duties as required: Efficient use of Human Resources in Mozambique

December 17, 2014
Journal of Pharmaceutical Policy and Practice

Journal Abstract: The crisis in human resources for health in low-income countries has been documented many times over by research and experience. A fundamental issue in human resources in the vaccine supply chain is the system in which the health worker is working, which requires more than training and revised guidelines to address.

Global Health: Science and Practice

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience

Global Health: Science and Practice – SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience. Read the full article published in Global Health: Science and Progress.

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience

January 28, 2014
Global Health: Science and Practice

SMS versus voice messaging to deliver MNCH communication in rural Malawi: assessment of delivery success and user experience. Read the full article published in Global Health: Science and Progress..

Integrating ODK Scan into the Supply Chain in Mozambique

December 1, 2013
UW, VillageReach, John Snow, Inc.

This paper describes our experiences integrating ODK Scan into the community health worker (CHW) supply chain in Mozambique. ODK Scan is a mobile application that uses computer vision techniques to digitize data from paper forms.


Supply Chain & Logistics

This is the summary of our work in the Supply Chain category on the VillageReach web site – under the “OUR WORK” section.

Robert Phiri, PA Graduate

The Start of a New Career: Robert’s Story
Robert Phiri is part of the first class of graduates from  the Pharmacy Assistant Training Program in Malawi, the result of a collaboration between the Malawi Ministry of Health, the U.S. Government through the USAID | Deliver Project, the Malawi College of Health Sciences, University of Washington Global Medicines Program, and Seattle-based NGO VillageReach. The program produces a dedicated cadre of individuals with enhanced training in medicines management and supply chain practices with a plan to eventually support each of Malawi’s 650 rural health centers.

Robert graduated in June 2015 and was placed at Lidzulu Health Center in Ntcheu District in June 2015 which serves a population of 45,000.


I enrolled into this program because I have a heart to serve the people, especially those in rural areas mainly in the health sector.

This program has trained me on how to manage medicines at the health center level. I have learned how to order medicines from central medical stores, how to provide good storage conditions to maximize the shelf life of the medicines, and how to control use of these medicines. This program has also given us…

Story: Violet Zamasonya, PA Program Graduate

A student essay by a graduate of the Pharmacy Assistant Training Program

The Immunization Supply Chain

This infographic shows the benefits and differences between a multi-tiered supply chain system and a streamlined approach based on VillageReach design, implementation and results of the Dedicated Logistics System in Mozambique, delivering a 17% cost savings and increased efficiencies across the supply chain.

Life Before the DLS: Antonio

“I am more present in the health unit since DLS started. Because I don’t have to travel to the District Sede do collect vaccines, through the DLS, the vaccines are delivered here. And now, we have vaccines available every day. I have more time to do my job, see the patients, organize data, etc. Before, I used to do at least 2 to 3 trips in a month to collect vaccines.”

Life Before the DLS: Emilia

Interview with: Emilia Albino Chilaule, Técnica de Medicina Preventiva, Centro de Saúde de Alto Changane, Distrito de Chibuto – A health worker who works in a health center served by the DLS.

Supply Chain Improvement

Click this link to see the full overview of this project via the IMPACT section of VillageReach web site. In 2010, VillageReach launched a national expansion of the DLS, currently serving more than 500 health centers and a population of over 8 million in five provinces.The DLS applies a comprehensive strategy providing: a streamlined distribution process, improved data collection and management through a locally appropriate information management system build on the OpenLMIS platform, and active and ongoing supportive supervision and training.

Pharmacy Assistant Training Program

The Pharmacy Assistant Training Program in Malawi is contributing to a robust pharmaceutical workforce through the introduction of a two-year certificate-level training program focused on improving medicines management and pharmaceutical practice at the health center level.

Health Center by Phone (CCPF)

Click this link to see the full overview of this project via the IMPACT section of VillageReach web site. Chipatala cha pa Foni (CCPF), or Health Center by Phone, is an mHealth innovation in Malawi designed to increase access to timely and appropriate maternal, neonatal and child health information, advice and care.

Human Resources for Health

This is the overview page on this web site that outlines our experience and capabilities around Human Resources for Health.

Press Release

Press Release: First Class of Pharmacy Assistants Graduate

Press Release: New Pharmacy Assistants Graduate in Malawi, Improving Patient Care at Critically Understaffed Rural Health Centers> Malawi College of Health Sciences, VillageReach, University of Washington and the Malawi Ministry of Health Collaborate on an Innovative Program.

2013 Gates Vaccine Innovation Award

February 4, 2013

PRESS RELASE: SEATTLE (February 4, 2013) —The Bill & Melinda Gates Foundation today announced the winner of the second Gates Vaccine Innovation Award.

Final 20 Expansion Grant

October 15, 2014

PRESS RELEASE: November 3, 2014 VillageReach Receives $1.8 Million from Bill & Melinda Gates Foundation To Expand Vaccine Delivery Initiative

Project Summaries

Organized Network of Services for Everyone’s (ONSE) Health in Malawi (ONSE)

ONSE is a maternal and child health systems strengthening program in Malawi aimed at reducing maternal, newborn and child mortality through a wide range of activities including improving access to better nutrition, family planning/reproductive health, malaria, and (WASH); improving the quality of these services through district level health system strengthening, and increasing demand for the services. The program incorporates a consortium of partners. VillageReach is responsible for supply chain strengthening activities from the district to the health centers to the village clinics. Key activities include rolling out the mobile health hotline CCPF nationwide with key mobilization activities in the 16 ONSE districts; expanding the use of pharmacy assistants as mentors to cluster facilities; providing oversight and capacity building for supply chain activities at the health centers; and improving health center and district’s ability to turn in timely and accurate commodity data reports…

Supply Chain Assessment, Modeling and System Design

In 2010, in partnership with the provincial governments and the central Ministry of Health, VillageReach launched a national expansion project to roll out the Dedicated Logistics Systems (DLS), a new approach to supply chain system design aimed at increasing vaccination coverage rates, reducing monthly stock outs of medical commodities, increasing health worker productivity and capacity, improving cost-efficiency, and improving the overall quality of health services available at the last mile. The DLS introduced new efficiencies to Mozambique’s vaccine supply chain resulting in significant increases in fully vaccinated children, dramatic reduction in stock-outs, and reduced costs. With additional support from the Bill and Melinda Gates Foundation, the DLS is now the cornerstone of the Accelerating Next-Generation iSC Program, an effort to encourage new models of vaccine supply chain system design in Mozambique and globally in order to reach the final 20% of children who currently do not have access to life-saving vaccines…

Kwitanda Community Health Program

Since 2008, VillageReach has led a program to increase the reach of health services at the community and health center levels by building capacity of community health workers, implementing cost-effective interventions to reduce malaria and diarrheal diseases in children under 5, and improving maternal and neonatal health through community-based interventions.

Pharmacy Assistant Training Program

In 2012, VillageReach began a three-year initiative to train and deploy a new cadre of  facility-based pharmacy staff to improve data management, decrease logistics burden on clinical staff and improve quality of care. The first cadre of students graduated in 2015.  Graduates are employed by the Ministry of Health to work in health centers in rural areas. Since 2016, VillageReach has transitioned to technical support for this initiative, passing ownership to the Ministry of Health and Malawi College of Health Sciences, while remaining active partners to help the Ministry reach its goal of training and placing a Pharmacy Assistant in every health center nationally – around 650 locations.  Initiative partners include the Malawi Ministry of Health, the Malawi College of Health Sciences, the University of Washington Global Medicines Program, and USAID | DELIVER…

mHealth Roadmap: Architecture and Design

In collaboration with Columbia University, PATH, and Vital Wave Consulting, VillageReach supported the Federal Ministry of Health in Ethiopia to develop a roadmap and set of requirements for a national information system to support the work of community health workers in Ethiopia. The original technical design workshops, facilitated using the collaborative requirements development methodology (CRDM), will lead to a national set of requirements that can be used by the ministry to evaluate and design comprehensive solutions that meet the needs of the primary healthcare system…

Systems for Improved Access to Pharmaceutical Services (SIAPS)

SIAPS is a USAID-funded program to improve access to pharmaceuticals. VillageReach’s role is to support Management Sciences for Health in an ongoing development effort to make the case for decreasing the burden of pharmaceutical and supply chain data collection in frontline health workers and increasing the focus on the key data points needed for decision-making.

People that Deliver

People that Deliver is a global partnership whose mission is to build global and national capacity to implement evidence-based approaches to plan, finance, develop, support and retain the national workforces needed for the effective, efficient and sustainable management of health supply chains. VillageReach is a member of the Advocacy & Knowledge Management and Research Working Groups, helping to promote the need for qualified supply chain professionals in public health systems and ensure that resources and best practices are shared across countries.


Pharmacy Assistant Training Program Overview

The Pharmacy Assistant (PA) Training Program in Malawi is contributing to a robust pharmaceutical workforce through the introduction of a two-year certificate-level training program focused on improving medicines management and pharmaceutical practice in health centers.

CCPF Case study by UNESCO-Pearson Initiative for Literacy

July 31, 2017
CCPF Case study by UNESCO-Pearson Initiative for Literacy

CCPF was a selected case study through the UNESCO-Pearson Initiative for Literacy: Improved Livelihoods in a Digital World. This case study is part of a series highlighting how inclusive digital solutions can help people with low skills or low literacy levels use technology in ways that support skills development and, ultimately, improve livelihoods – in contribution to achieving the Sustainable Development Goal on education. For more information

Finding Efficiencies in Zambia's Immunisation Supply Chain

September 1, 2017

Vaccines are at the core of Zambia’s efforts to prevent childhood death and illness and move towards prevention rather than treatment of disease. This piece provides an overview of Zambia’s Immunisation Supply Chain and the results of a recent modelling exercise.

Lições aprendidas em Alcançar o Projecto Final 20: Construindo uma Cadeia de Abastecimento de Vacinas de Nova Geração em Moçambique (Português)

Lessons Learned in Reaching the Final 20

This report provides a comprehensive overview of VillageReach’s immunization supply chain strengthening work under the Final 20 Project, included lessons learned and other insights for countries looking to move to an updated or “next generation” immunization supply chain. (Portuguese Translation)

The Role of System Design: Mozambique Impact Summary

October 28, 2016
Improved Immunization Supply Chains (iSC): Mozambique

This overview document provides a brief overview and explanation of system design, and how those principals have been applied in Mozambique with corresponding evidence of impact including significant increases in fully vaccinated children, reduced stockouts, improved cold chain uptime and other efficiencies, all at a reduction in government operating costs.

Portuguese           French

Lessons Learned in Reaching the Final 20: Building a Next-Generation Immunization Supply Chain in Mozambique

Lessons Learned in Reaching the Final 20

This report provides a comprehensive overview of VillageReach’s immunization supply chain strengthening work under the Final 20 Project, included lessons learned and other insights for countries looking to move to an updated or “next generation” immunization supply chain.


next-generation immunization supply chain: change leadership

Final 20 Policy Paper 5: Change Leadership - The Making or Breaking of an Immunization Supply Chain

January 19, 2016
Change Leadership: The Making or Breaking of an Immunization Supply Chain

Change leadership and effective management are critical ingredients for modernizing immunization supply chains (iSCs) to withstand current and future pressures and ensure all children have access to vaccines. This paper, co-authored with Andrew Brown and People that Deliver, explores the necessary leadership qualities of people involved in the transition to next-generation immunization supply chains, and provides recommendations and resources to help ensure these qualities can be fostered and developed.

USAID and VillageReach Data Burden Study image

Decreasing the Data Burden at the Last Mile to Improve Data Management and Use for Stronger Pharmaceutical Systems

August 24, 2015

Governments and their partners are acutely aware of the need for innovative ways to reduce the data burden on health workers. With support from the US Agency for International Development-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, VillageReach conducted a review of data management and use practices, particularly with respect to pharmaceuticals, in Malawi and Swaziland to better define and quantify the data burden facing health workers. This brief provides both context for and an articulation of the data burden seen within health systems in LMICs. It also provides recommendations for ways that ministries of health, donors, and implementing partners can rethink their approach to data management to improve health service delivery.

Paper-Digital Workflows in Global Development

March 14, 2015
Proceedings of the 18th ACM Conference on Computer Supported Cooperative Work & Social Computing

This paper examines the collaborative practices
around paper-digital workflows within global development
organizations operating in low-resource environments. We
use a mixed methods approach to gather data from 23
organizations in 16 countries. Our findings show the
tensions that arise between the ubiquitousness of paper
and the desirability of digitized data, and highlight the
challenges associated with transitioning information several
times between paper and digital materials.

Barr Foundation From Local to Global

Barr Foundation

Guided by a vision for a vibrant, just, and sustainable world with hopeful futures for children, Barr Foundation engaged with over 20 organizations striving to improve the lives of children and families living in poverty in East Africa,India, and Haiti. Read an exerpt from the report here featuring a progress report on VillageReach Pharmacy Assitants Program, generously funded by Barr Foundation.

Final 20 Policy Paper 2: Other Duties as Required

May 1, 2014
Final 20 Policy Paper 2: Other Duties as Required

Part Two of Reaching the Final 20 Policy Paper Series. This second paper in the series focuses on the role of human resources and the specific challenges facing individuals within the health system to adequately address the needs of vaccine supply chains, particularly in low resource communities. The Final 20 series looks at the different components of the supply chain, addresses the challenges faced at the last mile for distribution and presents examples of innovative approaches to address those challenges.

Mozambique: Strengthening the Community Health Worker Supply Chain

June 1, 2013
USAID Deliver Project, Task Order 4

A report of supply chain strengthening interventions focused on community health workers in Mozambique, covering antimalarial drugs, rapid diagnostic tests, male condoms, and essential medicines for a variety of treatments.


Changes at the Drugstore

Originally posted on The Medium.

Many health facilities across Malawi don’t have enough trained pharmacy staff to adequately manage stock and dispense medicines. These tasks often fall on health care providers, who already have many other responsibilities, namely caring for patients. In some cases, even a ground laborer or a security guard — who may have no training in pharmacy management — must step in to help.

Photo credit: Paul Joseph Brown for VillageReach

This critical gap is being filled by pharmacy assistants (PAs), a new cadre of health workers trained in pharmacy and supply chain management and deployed to rural pharmacies — and it’s showing promising results. Facilities with a trained PA report significant reductions in stock-outs and expired medicines and improved dispensing practices, important markers for pharmacy efficiency. The problem is, the country doesn’t have enough PAs to meet the need, particularly in rural areas.
To address this gap, Malawi’s Ministry of Health and Population (MoHP) and its partners teamed up with the USAID Organized Network of Services for Everyone’s (ONSE) Health Activity to initiate the Pharmacy Assistant mentorship program. ONSE, which is led by Management Sciences for Health (MSH) and implemented in coordination with…

Africa Health Agenda International Conference 2019 [Photo Gallery]

This year’s Africa Health Agenda International Conference focused on the theme: Multi-sectoral Action to Achieve Universal Health Coverage in Africa. VillageReach colleagues Alvo Ofumane, Lucky Gondwe, and Mr. Isaac Dambula from the Ministry of Health in Malawi represented VillageReach programs SampleTaxi, Project Izizi and Health Center by Phone respectively…

Last Mile Heroes

Ensuring access
Helena José Virgílio, José Maria, and Pedro Terezanane represent hundreds of heroes who, come rain or come shine, guarantee the availability of medicines and other medical commodities in health centers. As a result, patients countrywide have access to the medicines they need.  In addition to being the day-to-day heroes who ensure the availability of medicines in the health centers, they share the same expectations for the introduction of the Last Mile Supply Chain program.

The Last Mile Supply Chain (LMSC) program recently began its operations in Zambézia province and the initial results are favourable. Through a private logistics provider working closely with DPS Zambézia, products were delivered to 57 health facilities in the districts of Mocuba, Milange and Quelimane in December 2018.
Everyday heroes

Helena José Virgílio, an Administrative Assistant at the District Pharmaceutical Warehouse in Mocuba said, “We are very pleased because we see that something will change with the introduction of this new approach [LMSC]. Transportation has always been our biggest challenge. We used to rely on ambulances and motorcycles so that the health centers did not run out of medicines. The distribution was not coordinated, each health center sent…

Os herois da ultima milha

José Maria, Helena José Virgílio e Pedro Terezanane representam centenas de heróis que, diariamente, faça chuva ou sol, faça frio ou calor, garantem a disponibilidade de medicamentos e outros artigos médicos nas unidades sanitárias. Como resultado milhões de pacientes em todo o país têm acesso  aos medicamentos que necessitam para o seu tratamento em tempo útil.

Nos primeiros meses da implementação do Programa Cadeia de Abastecimento até à Unidade Sanitária (LMSC) na província da Zambézia, os resultados são satisfatórios. Só em Dezembro de 2018, 57 unidades sanitárias nos distritos de Mocuba, Milange e Quelimane receberam os medicamentos através de um provedor de serviços de logística privado, em colaboração com a Direcção Provincial da Zambézia.

Helena José Virgílio é Assistente Administrativa no Depósito Distrital de Medicamentos de Mocuba, José Maria é Fiel de Armazém no mesmo distrito, e Pedro Terezanane é o responsável do Depósito Distrital de Medicamentos em Milange. Estes partilham os mesmos desafios e as mesmas expectativas em relação à introdução do sistema de distribuição terceirizada de medicamentos, através do programa LMSC.


Getting Up To Speed: The Pharmacy Assistant Mentorship Program

Mbang’ombe 1 Health Center is in the back yard of Lilongwe International Airport. In terms of access to quality health services however, the facility might as well be far from Lilongwe. At approximately 50 km from the Lilongwe District Health Office and Central Medical Stores, the facility serves a rural community. It has one clinician, four nurses, 11 Health Surveillance Assistants (HSAs) and several support staff who serve over 5,000 households, a total population of 24,762 people. The facility has never had pharmacy personnel.

Laiford Nandolo is one of the two HSAs that help manage the drugstore in the absence of a trained Pharmacy Assistant. Although Laiford has over 10 years of experience as a health worker, most of his drugstore clerk experience has been on the job without formal training, except a one-day training he received back in 2014.

But something changed in early 2017 – Laiford and another HSA  joined the Pharmacy Assistant Mentorship Training Program. This mentorship program utilized Pharmacy Assistants, who are formally trained in pharmacy management and dispensing, to support nearby facilities like the Mbang’ombe 1 Health Center who do not have pharmacy personnel. Laiford began receiving on-the-job training…

Delivering on a Promise: Improved Data Helps Protect the Boso-Mbuki Community

I had the privilege of meeting Ruphin Ndumbala on my recent visit to Equateur province, DRC. Ruphin is one of the many frontline health workers who go above and beyond to ensure vaccines reach every last child. Recently, he made a promise, and I was honored enough to see him deliver.

“I used to spend at least two days’ roundtrip to collect vaccines.” Ruphin spoke outside of his clinic in rural Equateur province. “It was a big concern for my family that I was leaving behind, but also for the patients I was leaving unattended.”

In the Democratic Republic of Congo, vaccines must traverse a long journey to reach health workers like Ruphin. First, they are transported from the central level to provincial storage sites, where health workers from the surrounding health centers come to retrieve them. Ruphin, a registered nurse, works in Boso-Mbuki health center which is 71 miles away from the closest storage site. In a car, the distance may not seem long, but with very limited transportation options this journey is a hard one. To get to Boso-Mbuki, you must first take a canoe to Inkanza village and from there walk down a narrow path…

Bending the Arc: Why #HealthWorkersCount

The arc of the moral universe is long, but it bends toward justice.  – Theodore Parker

This week we celebrate World Health Worker Week.  I cannot think of a better testimony to health workers than those shown in “Bending the Arc”, a documentary chronicling the journey of the people behind Partners in Health.  The VillageReach team gathered to screen this film, which beautifully chronicles the health workers, patients, and activists who demonstrate the value of building a “preferential option for the poor” in health care.

“Bending the Arc” tells the story of health workers who showed up every day to make sure their TB or HIV patients took their medicines, had food to keep them strong during treatment, and had the social support needed to get through years of treatment.  Partners in Health hired and empowered community health workers (“accompagnateurs”) to reach patients directly, as a contrast to the westernized model of patients needing to reach health care facilities.  Then the organization used its influence to bring the evidence of this success to policymakers, global gatekeepers, regulators, and financing institutions and break down pervasive barriers to equitable and affordable health care.

One of the most powerful scenes in the movie shows…

Keeping Cool: A New Partnership with Bull City Learning

Vaccines are extremely sensitive to temperature. They must remain between 2 and 8 degrees Celsius in order to remain viable. Outside of this temperature range, vaccines become less effective at preventing diseases. Because of this, the storage and handling of vaccines need careful attention. The equipment and devices used to ensure vaccines stay in the right temperature range are known as the “cold chain.” When vaccines are transported, stored in a refrigerator, or used in an immunization session, the cold chain keeps the temperature right. Significant investments have been made in updating cold chain equipment in many countries, but overall performance remains a significant concern.

With our new partner Bull City Learning, VillageReach is strengthening the vaccine cold chain in Malawi. Using human-centered design principles, we are creating an easy-to-use, interactive, digital manual on refrigerator maintenance and repair. By providing this tool for cold chain technicians, we hope to improve routine maintenance of essential equipment used to keep vaccines at the right temperatures.

Global data shows that the maintenance of cold chain infrastructure gets weaker as vaccines move from higher levels of a supply chain towards the local level where the vaccines are used. Key observations from…

Waiting: Discovering and Addressing Inefficiencies in Malawi

One hundred and thirty minutes. That’s just over two hours. It’s a long time to wait to see a doctor no matter where you are in the world. Then after waiting for two hours, patients talk to a healthcare provider for less than 2 minutes – 140 seconds – before they are back out the door. These are the average times spent waiting for and with healthcare providers in a rural health center in Malawi, where a recent study examined the flow of patients to help uncover opportunities for improvement.

Malawi, like many low-income countries, faces a severe shortage of health workers. In a country of more than 16 million people, there are only 302 doctors – that’s more than 50,000 people for every one doctor. Because of these shortages, most health centers in Malawi rely on lower-level health workers to provide services. These workers share responsibilities far beyond patient care, so it important to find new, low-resource ways to support them in providing the highest quality service possible.

For example, this study highlighted the challenge of managing medicines and maintaining medicine availability in understaffed health centers. Not only did patients spend more than two hours…

When Health Workers Need a Helpline

Malawi has made incredible strides over the past few years to reduce morbidity and mortality, specifically among women and children under 5 years old. Key to this success has been a focus on using community health workers, known in Malawi as Health Surveillance Assistants (HSAs), to push direct healthcare services throughout the most rural, hard-to-reach, quintessential last mile communities. As a result, people who otherwise may not have reached a health facility can now access basic services from their HSA—sometimes even in their own homes. At the same time, however, more HSAs work in isolation or as the only person from their cadre within their area, with little interaction with colleagues, supervisors or other healthcare providers.

HSAs are typically responsible for areas of around 1,000 people each, often from two to three neighboring villages. HSAs live and work in these areas to better serve their clients, but this limits their access to information and advice from colleagues and supervisors. Similarly, rural health centers are run by medical assistants who have two years of post-secondary school education and are typically the only medical assistant or clinical officer at their site. Better communication and coordination between healthcare…

Graduated Success: When Programs Leave the Nest

Graduation season is upon us. It’s a time of reflection for those about to embark on a new phase of their lives. For many this means entering the workforce for the first time, a pivotal life moment.  At VillageReach, we recently celebrated the graduation of the second cohort of pharmacy assistants. Once deployed, these 85 graduates will begin careers as employees of the Malawi Ministry of Health and will be placed in rural, public-sector health facilities across Malawi. The 85 graduates will join their previous cohort who are already working in the field and making significant improvements in the quality of medicines management and patient care at the last mile. But this recent event is not the only graduation we’re celebrating.

The Pharmacy Assistant Training Program has reached its own “graduation” of sorts. As VillageReach transitions from leading implementer to technical advisor, others – government, donors and additional implementation partners – are now working to manage and fund the program at scale. Last month, VillageReach convened more than 35 program stakeholders, inclusive of the Malawi Ministry of Health, USAID | DELIVER, Malawi College of Health Sciences, and Imperial Health Sciences, to determine the strategy for meeting the Ministry’s goal…

Championing the Next Generation of Immunization Supply Chains in West Africa

In 2014, Africa.com published a list of the 10 jobs that will be the most sought in Africa in the near future. It comes as no surprise that logistics and supply chain management related jobs made it to the list, identifying supply chain managers as a driving force of economic growth in Africa.

After attending the recent Immunization Supply Chain Leadership Conference in Abidjan, I felt that this was also true for the public health sector. The eleven African countries represented were all speaking with one voice: they need the right person at the right place to lead the next generation of immunization supply chains (iSC).

Universal vaccine access is a global health necessity in Africa, as vaccination is one of the most effective ways to prevent the deaths of millions of children. Rightfully, Ministers of Health all over the continent gathered in Addis Ababa in February to reinforce their commitment to expand vaccine access to every person on the continent. Recognizing this goal cannot be achieved without proper supply chains or supply chain managers, conference participants built on this commitment to develop a Call to Action requesting stronger engagement of decision makers to create a favorable environment for…

Your Support: Reaching More with CCPF

We are pleased to announce that the Johnson & Johnson Foundation has become one of the key partners in championing Chipitala Cha Pa Foni (CCPF) as it advances towards national scale. The Johnson & Johnson Corporate Contributions is a known supporter of community-based health care solutions that strengthen the health workforce, save and improve the lives of women and children and prevent disease among the most vulnerable.

What do vaccines and vending machines have in common? Using data to improve vaccine delivery in Benin

A blog describing VillageReach work with AMP in Benin to implement OpenLMIS. In Benin, OpenLMIS collects critical supply chain data at the “last mile” of healthcare, where data visibility and accuracy is most important, providing a solid evidence base to inform decision makers on future national policies and support the data needs of Logivac+, an informed push distribution system for immunization commodities.

The Role of Paper to Digital Data Solutions

In response to this article by Dr. Mahad Ibrahim on the role of data during the Ebola outbreak, some interesting questions were sparked among our team. The piece evoked a lot of great insights about the opportunities and challenges the piece addresses, as well as how we see those topics evidenced in our VillageReach work. This topic is of particular interest to us, as we and our partners at the University of Washington are actively developing and testing an open-source tool for paper to digital data conversion, ODK Scan. ODK Scan is an Android app that uses a smartphone’s camera and custom image recognition processing to automatically digitize information from paper forms. Our work with ODK Scan and our experience with digital tools in other programs has informed much of our understanding of this paper to digital question. Below are some general themes that regularly surface in our discussions, plus some specific examples from our experience.

Direct to digital tools often prove challenging in actual field use

The challenges that Dr. Ibrahim describes in direct-to-digital data collection are absolutely supported by our experience with various projects in this space, particularly in regards to duplication of data…

Addressing HIV and Immunization Needs From The Same Truck: A new public-private partnership aims to support HIV treatment at the last mile

Today the world recognizes World Aids Day – a day to unite in the fight against HIV and to support the millions of people around the globe living with HIV.
In conjunction with World Aids Day, Médecins Sans Frontières (MSF) has published a new report – Empty Shelves, Come Back Tomorrow – evaluating the current incidence of HIV for four of the worst HIV-affected countries in sub-Saharan Africa including Mozambique.  In the country, 11% of the adult population is HIV positive, but only 45% of those affected receive the required level of treatment.   As the report notes about Mozambique “… there is no funded regular last mile delivery and stockouts are seen at facility level.”
 “11% of the adult population is HIV positive, but only 45% of those affected receive the required level of treatment… there is no funded regular last mile delivery and stockouts are seen at facility level.”
Leveraging our last mile delivery experience in Mozambique and other countries, VillageReach is seeking to address this problem.  This week, in collaboration with the Tete Provincial Health Services Department, MSF, and commercial transporters, VillageReach launched a new public-private initiative to improve the availability of medical commodities at the last…

Lessons Learned from Brazil's EPI Program

BLOG: This week, the team of VillageReach is participating in the “Jornadas de Saude” (Mozambique health fair). We attended today a very impactful presentation on successes and challenges on the introduction of multiple vaccines into the EPI program in countries with limited resources.

Data, Dashboards and Decisions – The Components of Building a Better Supply Chain

A blog about the expansion of OpenLMIS (SELV) in Mozambique and our expanding role in advocating for better data visibility and analytics as a key component of vaccine supply chain improvement.

Pemphero’s Story – A Day in the Life of a Health Surveillance Assistant

Blog from VillageReach Community Health Faciliator in Malawi, explaining the critical role of VillageReach-supported Health Surveilance Assistants and village clinics.

Five Lessons For Closing the Immunization Gap

Through our daily interactions with health workers and government partners, I’ve seen first-hand the challenges to achieving immunization equity, especially as new vaccines are being added to already strained systems.

Following are five important lessons I’ve learned which I believe will help close the immunization gap

Smartphone App to Improve Health Assessments of Women and Children in Rural Villages

How can smartphone apps improve health assessments in rural villages? This is precisely what VillageReach, in partnership with D-tree, is figuring out. During the first week of February 2015, 25 health surveillance assistants (HSAs), nurses and other health workers received intensive training on smartphone technology and the capabilities of a new maternal and neonatal health (MNH) assessment application designed by D-tree.

Making Sense of Maternal and Child Mortality

Blog by Melissa Sanchez, VillageReach.
To strengthen and supplement the inconsistent and incomplete reporting mechanisms within Kwitanda, VillageReach has undertaken several new initiatives to better understand the questions above.

A Relief for Rural Health Workers

BLOG: “The Pharmacy Assistant Training program is a very exceptional program because it is practicum- oriented. The student assigned to our health center the past five months is already doing an amazing job. I am no longer dispensing, or dealing with supply chain issues other than approving issues and orders. Now, I am able to see more patients in a day, and provide more thorough examinations.”

My Journey to the Pharmacy Assistants Training Program

This programme, therefore is very important because it will help in combating some of the problems that many health centres are experiencing in Malawi. It will help fill the gap that currently exists in terms of qualified pharmacy assistants in the health centres. With better trained pharmacy personnel, there will be proper record keeping, good dispensing skills…

The Illusive “Other Duties as Required”

In the Mozambique health system, this has become the catchall phrase for health workers. They are tasked with numerous responsibilities including the supply chain function, resulting in a crisis for human resources for health…

Testing New Ways to Improve the Cold Chain

While technology has become more and more common in addressing issues of health care in low resource communities, the most effective solutions are usually the most accessible and inexpensive, and ColdTrace is an example of such a technology.

The Best Remedy

VillageReach Pharmacy Assistants Program Student– Class of 2015

My name is Clifford Kanono.  I am enrolled in VillageReach’s Pharmacy Assistant Training Programme. Previously, I worked as a Health Surveillance Assistant in the rural communities of Nkhata Bay District in the Northern part of Malawi. The health facility I worked in had to serve about 14,500 people in a year—a large number given the resources of the facility.  This, like most other health facilities in rural communities face many challenges, but one of the most problematic is the adverse effects of non-trained pharmacy personnel:

Poor stock management resulting in frequent stock outs of medical supplies
Expiry of the medical supplies before they are used
Dispensing of medicine by unqualified staff who cannot give adequate information about the medicine to the patients
Heavy workload – patients spend more time waiting for medication due to understaffing
Poor documentation,  reporting and organization of medical supplies

Having observed such challenges on a regular basis was concerning to me, so when I saw the announcement of a new training opportunity by the Malawi College of Health Sciences (MCHS), Ministry of Health (MoH) and VillageReach, I very much wanted to join…

How a Phone Call Saved a Life

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.

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