Thoughts from the Last Mile Welcome to the VillageReach Blog

Tag Archives: Vaccines

06.26 2015

Olivia Vargas is currently in Mozambique conducting a midline evaluation of the ColdTrace pilot program, a remote temperature monitoring system for vaccines currently operating in the southern portion of the Gaza Province where she recently visited a vaccine warehouse as inspiration for this blog.

Vaccines come with a lot of accessories. They are the friend that shows up with four suitcases for a weekend getaway. The friend that packs for every possible weather scenario, and the friend that takes the longest to get ready to leave the house. I learned this lesson while in the Mozambican province of Gaza. I got a tour of the provincial warehouse where all the vaccines are stored before they are distributed to district health centers and remote health posts.

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06.05 2015

The 15th TechNet Conference convened last month in Bangkok, bringing together a global network of professionals and practitioners committed to strengthening immunization services in developing countries.  As my first time attending, it was a great opportunity to “geek out” about vaccines with a whole bunch of other vaccine “geeks.” The conference presented a mix of global policies and trends, as well as presentations from different countries on innovations for the vaccine supply chain that are improving efficiencies and increasing vaccine coverage rates. It was an opportunity to share experiences and learn from others’ work around the world.

Tech Net-21

Tech Net-21 Group Photo, courtesy of TechNet-21

A few key themes emerged from the conversations and presentations during the conference:

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04.28 2015

For the last fifteen years, VillageReach has been working to help ensure all children have access to vaccines. I have had the opportunity to spend time in rural health facilities across sub-Saharan Africa, talk with hundreds of healthcare workers, and meet with numerous leaders of health ministries. 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.

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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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07.10 2014

BerturBy Bertur Alface
Medical Chief of Gaza Province in Mozambique
Reposted from Impatient Optimists.org

 

Change does not come easily, particularly to systems that have been operating in a specific way for a long time and where many people have a stake in the decision making. But sometimes it becomes clear that change is necessary to improve how things operate.

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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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04.03 2013

(This blog was originally posted at Next Billion).

One of the harsh realities of the current state of global health is that the quality and supply of life-saving innovations exceeds the capacity of many health systems to deliver them. Exciting new innovations are being developed. But for many low-income countries, gaps in the underlying infrastructure to support their delivery – especially for rural areas – limit the potential of these innovations to improve health care.

In our experience at VillageReach, looking at the problem from the point where health care is delivered to patients ensures that capacity development focuses on the weakest link – the last mile – but also where underlying infrastructure is most limited. We’ve determined that private enterprise has a significant role to play in developing the infrastructure necessary to achieve sustainable improvements in health care.

Vaccine development – arguably global health’s greatest innovation – is a case in point. With billions invested, the aggressive introduction of vaccines has saved millions of lives. But subsequent gains have been more elusive: Many low-income countries have seen immunization rates essentially stuck at 80 percent. GAVI Alliance CEO Seth Berkley estimates that today as many as 22 million children are unable to access vaccines. More than two million die from vaccine-preventable diseases every year.

Efforts to reach the remaining 20 percent – the Final 20 – have been insufficient, largely because much of this neglected population is rural and remote. For many of these communities, long travel distances, minimal transportation services and high poverty rates prevent mothers from making their kids available for immunization and other basic health care measures, raising the cost of health services. Families with sick children find it more difficult to exit poverty, and their communities have fewer opportunities to advance.

Investing in Community Infrastructure
With so much investment and innovation in vaccine development, we should be looking to where leverage can be applied to fulfill that promised value. Much of VillageReach’s work has focused on improving vaccine delivery by increasing frontline health worker productivity and capacity, and making information technology more useful and practical in the field in order to improve data reporting and performance measurement. Our model also leverages private enterprise to develop common infrastructure that both health systems and the communities require.

In creating opportunities for investment in infrastructure, we look at gaps in key community services – transport, communications and energy supply, for example – that limit health care delivery. The intent is to address the health access and capacity problem by creating enterprises that also serve commercial customers in order to achieve financial sustainability.

This focus on infrastructure isn’t only to provide single solutions for common problems. The economic multiplier is higher for investments in infrastructure than in other sectors, since the construction of roads, bridges, communications, and energy supply networks employ workers and enable commerce. World Bank President Jim Yong Kim acknowledged the importance of this link recently, noting that investment in Africa’s infrastructure increased from 16 percent to 22 percent of GDP over the past decade. Africa’s 5 percent annual GDP growth during the period is greater than for any other region worldwide.

Supplying Energy for Mozambique’s Health System – VidaGas
Mozambique and its health system have faced many of the same challenges of other countries in sub-Saharan Africa. Much of the population lives in remote communities that are difficult to reach. Less than 35 percent of the country has access to the electrical grid – access is much lower for rural communities. Health services are also impacted: The supply of vaccines to rural health centers is irregular due to the great travel distances involved, and limited refrigeration results in wasted vaccine stock. This lack of reliable energy also impacts health center performance well beyond vaccine delivery, making it difficult to sterilize medical equipment and provide the necessary lighting for procedures conducted after dark.

We set a goal of improving the capacity and reducing the cost of health care delivery in Mozambique. It was clear that a solution was required that would address the critical gap in energy supply affecting the performance and economics of the cold chain for the health system. It was also clear that the solution must be sustainable by attracting broader demand for the service.

In 2002, we established an energy services company, VidaGas, in partnership with Fundação para o Desenvolvimento da Comunidade (Foundation for Community Development). When VidaGas was created, the initial network of rural health centers comprised 100 percent of gas shipments. Today, that percentage is 17 percent. The majority of VidaGas’ service is now directed at enterprise customers – restaurants, hotels, small factories, and a growing retail network that enables households to replace traditional wood and charcoal that produce harmful indoor pollutants. The message is that without revenues from the private sector, the company wouldn’t have the resources to support its obligations to the health system.

The company’s growth – in excess of 35 percent annually since 2010 – has accelerated with additional capital investment from Bamboo Finance/Oasis Fund. Today, VidaGas is expanding its operations into new geographies and market segments. The company is now the largest independent energy services provider in northern Mozambique, with three large-tonnage storage and filling facilities across the region serving five provinces and more than 50 percent of the country’s rural health centers.

We anticipate similar growth in the future, as the business expands its base of enterprise customers, builds a larger retail network to reach more households, and expands operations into new provinces in order to supply more rural health centers.

John Beale
Group Lead, Social Business

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06.08 2009

So who is paying attention to medical distribution systems and more specifically to the innovation pile-up we highlighted in the last post?

There are 4 main categories of players: Governments, NGOs, multi-lateral organizations (WHO, UNICEF) and public-private alliances.  While there are many, many important and interesting stakeholders in the field, the most interesting evolution over the last decade has been the ways these groups cross boundaries to find creative ways to work together.

When Global Alliance for Vaccines and Immunization (GAVI) was established in 2000, it had an enormous impact on the field of vaccines.  GAVI refocused attention on vaccine-preventable diseases which waned in the 90’s after the highly successful immunization campaigns of the 70’s and 80’s. gavi-logoAnd as a public-private partnership funded by donor governments and private organizations such as the Bill & Melinda Gates Foundation, it brought serious financial resources to the table (over $2 billion of net assets in 2007).  Currently, GAVI supports 72 low and middle-income countries in vaccine financing and procuring.  While considerable resources at GAVI have been directed towards augmenting the supply of existing vaccines and developing new vaccines, GAVI and its stakeholders are increasingly beginning to consider the inadequacies of the health systems into which these vaccines must enter.

One particularly interesting initiative is The Optimize Project, a joint collaboration between the WHO and PATH.  The Optimize Project seeks to identify and advocate for the “immunization systems and technologies for tomorrow.”  Funded by the Gates Foundation, the Optimize Project is a recognition that discovery and development of vaccines is only half the battle.

Here at VillageReach, it has been exciting to see the development of enthusiastic recognition and articulation of the problems of logistics at theLast Mile.

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06.05 2009

Welcome to the VillageReach blog! This blog follows VillageReach’s progress as well as interesting ideas, projects and events at the intersection of health with social enterprise, technology & logistics.

We ’re launching with our thoughts on the “Innovation Pile-up.” Chris Elias, the Executive Director of PATH, coined this phrase to describe the coming challenge facing public health systems around the world as years of medical research and development, particularly for vaccines, come to fruition.

When VillageReach started working in Mozambique in 2001, we found there was no system for distributing medical supplies beyond the provincial level … a situation that’s unfortunately the norm in most developing countries.

The Mozambique system was chaotic and under-resourced in 2001. Since then, the world has begun to invest heavily in new medical products, such as vaccines, to address the huge disease burden affecting developing countries. Governments, international organizations, and private charities have spent trillions of dollars in research and development of new products. But new opportunities bring new challenges. The new vaccines just starting to become available are much more expensive and are physically, much larger.

For example, polio is a basic vaccine administered around the world today. Twenty doses of polio fit in a vial about the size of your little finger. At 13 cents per dose, the vial is worth only a few dollars. A twenty-dose, polio vial doesn’t take up much room in the refrigerator, and if the distribution system ruins a few vials, or has a few leaks in it, then the loss is not huge.

In contrast, one new vaccine to prevent rotavirus, a stomach bacteria that kills thousands of children every year, costs $5 and is the size of your fist. The HPV cervical cancer vaccine is expected to be priced between $50 and $100 per dose in developing countries. The malaria and HIV vaccines, which we hope are coming soon, are also likely to be very expensive. Current distribution systems are overwhelmed now; the new products will swamp them.

Unless we invest in improving the ability of developing countries to handle these new products, trillions of dollars of investment will be wasted and, more importantly, children in those countries will once again, be passed by. While we can get excited about new product developments, and rightly so, we can’t forget that our job is not done, until drops are in mouths, and needles are in arms.

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