Last week, the Reproductive Health Supplies Coalition (RHSC) brought together hundreds of the top minds in global reproductive health issues at the Coalition’s 17th Annual Meeting. This meeting provided a forum for discussing the many triumphs and continuing challenges of reaching 120 million additional women with reproductive health services by the year 2020. Access to reproductive health commodities allows women to decide if and when to have children. This ability is not only a human right, it can be a life or death situation for many women and young girls. Increasing access to reproductive health is also one of the most effective and cost-efficient ways to reduce infant and maternal deaths. As an active member of the RHSC’s System Strengthening Working Group, VillageReach eagerly engaged in this week of conversation and idea exchange. Many of the central themes reflect the work of VillageReach, allowing us to bring our experience and expertise to the conversation while learning and growing from the experiences of our partners.
Global health innovation requires us to think beyond an individual product – it’s about creating space for “last mile thinkers” to meet with the scientists and engineers whose work influences medicine availability and healthcare access in low- and- middle income countries. This is how VillageReach found itself on a stage next to representatives from GlaxoSmithKlein, Pfizer, Washington Global Health Alliance, and the Controlled Release Society, engaging in conversations about what medicine delivery means in the context of global health.
Tremendous time, resources, and efforts are invested in developing new, more effective medicines that can improve quality of life – some of these medical breakthroughs have promise to control or eliminate diseases that costs thousands of lives each year. But the challenge of delivering these innovations in low-resource settings remains a pervasive barrier to improving health care access and outcomes. New products have unintentionally strained fragile health systems. Health supply chains for example, designed decades ago, struggle today to deliver a wider range of medicines to larger populations. Infrastructure and human resource challenges limit the impact of these innovations. Life-saving medicines sit on shelves in a warehouse, or expire in broken refrigerators at a rural health facility – many of us who live and work at the last mile of rural communities are familiar with this “innovation pile-up.”
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
After spending nearly two weeks in an intensive course offered by the Institute for Health Metrics and Evaluation for its incoming fellows (and a couple of fortunate UW graduate students like me), I have an even greater appreciation for the role of evaluation in our work in global health and for the complexity and difficulty in doing it well. In her lecture on Evaluating Health Programs, Dr. Emmanula Gakidou, pointed to what is called “The Evaluation Gap” where billions of dollars from international donors and national governments are being channeled into health programs in low and middle income countries but we know relatively little about what programs are working and how well they are working. The reason being is that most of them are not rigorously evaluated.
Even while researchers continue to develop and test new interventions such as vaccines, diagnostic tools, and drugs through thorough clinical research, we don’t know how best to deliver them in countries with weak health systems. The result is an innovation pile-up where proven interventions to prevent and treat disease are available yet millions of people are dying because these interventions don’t reach them.
As a graduate student in public health, it seems to me that the field of global health is turning in this direction and placing a lot more value on measuring impact. As President Obama said in his speech at the MDG Summit; “let’s move beyond the old, narrow debate over how much money we’re spending and let’s instead focus on results-whether we’re actually making improvements in people’s lives.” We need to know what is working and what isn’t so we can better our efforts and get the interventions out to the people who need them.
Unfortunately, evaluation is difficult to do well. As I quickly learned in the IHME course, there are some serious limitations to deal with ranging from poor data quality and availability to the fact that the methodology of conducting a rigorous evaluation just sometimes isn’t possible or is really expensive. As expressed in a Lancet editorial: “Evaluation matters. Evaluation is science. And evaluation costs money. It’s time that the global health community embraced rather than evaded this message.”
VillageReach makes a sincere commitment to evaluation of its programs and has ever since its inception. For example, as we begin to scale-up the Dedicated Logistics System in Mozambique, we are engaged in operations research to inform our program decisions. In addition to routine monitoring, we are conducting baseline evaluations in every province followed by process and outcome evaluations. We want to know what is working and more importantly, what isn’t working and why, so we can ensure that the resources we put into our programs really make improvements in people’s lives and that those interventions make it to the people who need them. We’ll keep you posted on our progress.
Jessica Crawford, MAPS, MPHc