Thoughts from the Last Mile Welcome to the VillageReach Blog

Tag Archives: Supply Chain

08.28 2014

A few weeks back, my colleague Rachel Powers wrote about VillageReach’s customized deployment of an open-source electronic logistics system (OpenLMIS) in Mozambique, where it is referred to as SELV (Sistema Electrónico de Logística de Vacinas). Along with members of our team, she and I have been closely working together in the development, user testing, and launch of SELV in-country. When I facilitated a week-long training in Maputo in June this year, the excitement I felt about SELV and the positive changes it could bring about was reflected in the faces and attitudes of everyone present in the room. The 15 people being trained included a mix of provincial-level vaccine logistics staff who would use the system regularly and central-level government officials in-charge of country-wide vaccine logistics and monitoring and evaluation of newborn and child health statistics.

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08.11 2014

Since beginning my technology associate internship at VillageReach, I’ve learned that strengthening health systems in developing countries requires reliable health information and improved decision-making capacity at all levels. Without real information on who needs what and where things are going it’s impossible to keep health centers supplied with the commodities they need to treat their patients.

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07.29 2014

When VillageReach began work with the Supply and Awareness Technical Reference Team for the UN Commission on Life-Saving Commodities for Women’s and Children’s Health to document promising practices in supply chain management, I was both excited and daunted.  Excited because there is a growing recognition that strengthening supply chains is a fundamental aspect of increasing access to medicines and quality healthcare at the last mile; daunted because while there is so much work being done to improve supply chains in low and middle income countries, documentation and evidence of these interventions can be hard, if not impossible, to find.

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07.17 2014
How HERMES modeling tools allow decision-makers to see the impact of vaccine supply chain system changes- before they “buy.”

You may not think that the world of fashion relates to vaccine supply chains, but let me make the connection. When shopping for that perfect outfit, sweater or shoe- I can go to a store and try on all kinds of options—different sizes, styles, colors, and all combinations therein. And then, with a lot of help from my friends, I can pick the best option for that particular occasion.  When that purchase becomes outdated, worn out or just doesn’t fit anymore, this process can be repeated.

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07.17 2014

By Sir Brian Greenwood
Professor, Clinical Tropical Medicine
London School of Hygiene & Tropical Medicine
Advisor, Vitol Foundation

In June I was asked to  visit the Village Reach project in Malawi by one of its funders – the Vitol Foundation.

Dispensing is an important but neglected area and VillageReach is to be commended on recognizing the need for more investment in this area. Malawi has very few trained pharmacists or pharmacy technicians and so much dispensing at the health centre level is done by completely untrained people with a substantial risk that drugs will be wasted and that patients may be given the wrong medication. Pharmacists are trained at the School of Health Sciences in Lilongwe. Fully trained pharmacists undertake a four year course, pharmacy technicians a three course leading to a diploma. A new cadre of pharmacy assistants has been created by the Ministry of Health and VillageReach, with 150 enrolled in the first year. The ultimate goal is to place one pharmacy assistant in each health centre.

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06.03 2014

wendy-300x200By Wendy Prosser
VillageReach Program Manager
USA and Mozambique

How many times have you seen “other duties as required” on a job description? It infers any random thing that may not fit perfectly into other well-defined responsibilities but still needs to get done, so there is a high likelihood that it may land on your desk to take care of.

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. A maternal and child health nurse, particularly in a rural area, is responsible for providing antenatal care, assisting with deliveries, vaccinating children, managing data for all health clinic activities, and completing requisitions of commodities to keep drug supplies well stocked.

Basically, a nurse in a rural area becomes a Jack of All Trades and a master of none.

Professor Saracino, the former Minister of Health in Côte d’Ivoire, summed it up well:

“When you use a nurse or a physician as a logistician, you lose the nurse or physician and you don’t get a good logistician!”

In this sense, becoming a “Master of ONE” as opposed to “NONE,” is one aspect of the Dedicated Logistics System (DLS), a different approach to supply chain management that VillageReach is developing, through the Final 20 Project supported by the Bill & Melinda Gates Foundation. The DLS has shifted supply chain management responsibilities to the hands of a few dedicated personnel. The DLS moves supply chain management functions as high up in the supply chain as is geographically feasible, consolidating tasks at the provincial level so that limited resources available can be dedicated. This frees up a health worker’s time to focus on patient care.

When I visit Mozambique and accompany a vaccine distribution, I see the benefits of this system firsthand. The dedicated logistician checks records and manages the stock while the nurse cares for the many dozens of children waiting for her. The DLS has reduced lines and waiting times, enabled the health workers to focus adequately on primary care, and dramatically improved the reliability of the supply chain, thus increasing trust in the health system.

We have documented this approach, and the role of human resource management in improving vaccine supply chains in the Reaching the Final 20 Policy Paper Series, available here.

For more information on the DLS, and VillageReach work in Mozambique

About the Author: As Program Manager, Wendy Prosser is responsible for the design, implementation, and monitoring and evaluation of health system program for VillageReach in Mozambique. Efforts in Mozambique seek to streamline vaccine logistics with an improved logistics management information system and transport services. Wendy has over a decade of global health experience in program development and management, research and analysis, capacity building, and behavior change communications. This experience has taken her to Mozambique, Malawi, Angola, Kenya, and South Africa in various public health settings, starting with Peace Corps in Cape Verde. Wendy holds a MPA in International Development and Global Health from the University of Washington.

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05.23 2014

Reposted from the Bill and Melinda Gates Foundation BlogImpatient 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: 

New ColdTrace technology developed by Nexleaf provides SMS alerts with real-time information for cold-chain monitoring in Mozambique.

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 5.6.2014

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11.25 2013

We recently posted the latest performance report update for the Dedicated Logistics System (DLS) in Mozambique, covering January – June 2013. You can find the report here.

The implementation of the DLS is conducted in close partnership with the Mozambique Ministry of Health and provincial governments to improve access to vaccines for millions lacking sufficient healthcare in four of the country’s ten provinces. The focus of the program and the metrics we track concern vaccine distribution, one of the most cost effective interventions to save a life.

These reports, which reqire government approval for us to publish, cover a variety of metrics including:
• Health centers visited and data reported
• Delivery of vaccines
• Stock outs of vaccines
• Functioning refrigerators
• Number of vaccines administered

For the health centers receiving deliveries of vaccines from the DLS, vaccine stock outs continue to be below ten percent. More than 95 percent of refrigerators at health centers are functioning within the range necessary to ensure vaccines remain at desired temperatures. At the same time, the timing of vaccine deliveries is not as high as our target … this is a work in progress as we assist the provincial ministries of health to absorb the logistics system into their budgets and workplans.

Please feel free to send in your comments or questions to info@villagereach.org.

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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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