Transformational change does not always happen overnight. In the case of immunization supply chains (iSC), real transformational change requires iteration. It is a process of continuous improvement: cycles of thinking, testing, and improving to constantly push the system forward. While the final result might be a complete redesign of the end-to-end supply chain, each step along the way is a necessary part of getting to a better model. Sometimes the wheels of change move quickly, when political will is aligned with resources and capacity. Sometimes the wheels move more slowly, during phases of learning and refining new ways of doing things. With any large-scale change, the key is to never stop moving forward.
Having been in my new role as President of VillageReach only a few weeks, each day is filled with new “firsts.” First staff meeting, first attempt to work the phone system (failed), first presentation (so-so). Among them was my first—but certainly not last—Final Mile Logistics Working Group Happy Hour hosted by Lynden International. At VillageReach, we focus on increasing access to quality healthcare for those living in the most difficult-to-reach and underserved communities where basic, routine health care delivery is a huge challenge. For us, supply chain and logistics are essential elements of addressing that challenge, so it was great to meet and talk with representatives and leading thinkers from Puget Sound-area companies and our WGHA colleagues who share our interest, have a passion for new ideas, and apply them on a global scale. Who better to help us think through the challenges and opportunities of last mile delivery?
Bringing a program to scale can’t be done single-handedly. It requires the commitment of partners working collaboratively towards a common goal and a dedicated team to keep up momentum as new and unexpected challenges arise. Sometimes, key individuals drive a project forward. They find themselves in the unique position to motivate partners and steward the larger team. Upile Kachila is one of these people.
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.”
Reposted from the Bill and Melinda Gates Foundation Blog: Impatient Optimists 5.6.2016
I recently returned from a week in Mozambique with a goal of learning about new immunization supply chain models and observing their impact. I also wanted to better understand opportunities and constraints for taking this work to scale — in Mozambique and across other Gavi-eligible countries.
In 2013, the Gates Foundation began working with five provincial governments in Mozambique, the national ministry of health, and VillageReach on a new system for delivering vaccines. The new system represented big changes over their current design. It takes a holistic approach – reconfiguring the transport system, re-assigning roles and responsibilities of personnel, obtaining and using data differently, and integrating supervision and cold chain maintenance into monthly vaccine distributions. I was able to get a first-hand view and see some impressive results of this “next-generation” system while in southern Mozambique’s Gaza Province. In Gaza, there’s now a much better chance that when children show up at a health center for immunizations, the vaccines will actually be there. Vaccine stockouts have dropped from 43% in 2012, before the province revamped their system, to routinely less than 3% today.Read full story
Many people in global health talk about how Coca-Cola supply chain practices could be applied and adapted to health commodities to ensure that vaccines, malaria treatment, family planning commodities, and many more essential medicines are available at the last mile health facilities. And they have a point—I have seen Coca-Cola in pretty much every village I’ve been to in Africa throughout my almost 20 years of going to these remote places.
However, that cannot be said for the south part of the Equateur Province in the Democratic Republic of Congo.Read full story
Reposted from the Bill and Melinda Gates Foundation Blog: Impatient Optimists 5.6.2014
As a Technical Officer with VillageReach, I am responsible for working with our partners at the provincial health department and in the health centers to support new cold chain monitoring technology. In this role, and in my experience visiting rural health centers, I see firsthand the many challenges that exist in infrastructure, issues that greatly impact the cold chain and viability of vaccines. Energy in our communities is unreliable, so often times the refrigerators that store vaccines and other medical commodities lose power for hours or even weeks at a time. Health workers struggle to balance the time needed to adequately treat patients with their other administrative duties, and fixing a broken refrigerator is not part of their training. As all of these situations effect the viability of vaccines, they also affect the children who need them. A better cold chain can save lives. That is why I am excited about the opportunity to observe a simple new technology solution that I think could have great impact in solving these challenges.
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. ColdTrace is a low cost solution that leverages the power, coverage and availability of mobile telecommunications services in remote/hard to reach areas to improve response time to problems in the Cold Chain Storage System. ColdTrace is a low-cost cellular phone which has a sensor added to it that can read and monitor temperature. VillageReach is working with Nexleaf to deploy and test ColdTrace devices in 90 health centers in Mozambique starting in May 2014.
How it works:
The phone with the built-in temperature sensor is installed in a central position of the fridge that holds the vaccines. The phone records the temperature at pre-configured intervals. When temperatures go out of the stipulated range, i.e. 2°C – 8°C for a pre-defined period, text messages are sent from the ColdTrace device to clinic staff. If the problem is not resolved within a certain period, escalated messages are sent to the District EPI (Extended Programme on Immunizations) Officer. If the problem is still not resolved, another escalated SMS is sent to the Provincial EPI Officer. Because this communication all happens so quickly, the time it takes to actually fix the equipment and get it back to operational is much faster than it would typically be. The SMS sets in motion a communication that is continually managed and repeated in the daily status messages until the problem is resolved. All the data is gathered and processed by ColdTrace and is uploaded to a central server and summaries of these data are sent on a monthly basis to the Ministry of Health.
What are the benefits of ColdTrace to immunization programs?
Through this initial deployment, we aim to show that ColdTrace:
- Gives time back to health clinic staff enabling them to focus on their primary job of caring for patients instead of maintenance issues.
- Decreases the time it takes to identify a problem and coordinate the resources to fix it due to an immediate and ongoing communication that initiates with ColdTrace.
- Provides the Ministry of Health in Mozambique with critical data needed to evaluate the performance of various clinic response times, as well as different models of refrigerators, helping to improve informed decision-making.
I look forward to seeing the results of ColdTrace in Gaza Province so that VillageReach can share what we have learned about this new technology along with our partner, Nexleaf, and help bring a cost-effective, sustainable solution to more communities in need of cold chain support.
Reposted from the Bill and Melinda Gates Foundation Blog: Impatient Optimists 5.6.2014Read full story
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.