Did it work? This question is integral to our lives. Did my Toyota come to a stop when I pressed the brakes? Did my headache go away after I took Tylenol? We don’t always realize it but we are constantly conducting evaluations. These questions and answers contribute to our understanding of what works and what doesn’t work so that we avoid repeating the failures.  The concept is pretty simple, so shouldn’t it also apply to the health programs we support?

It appears that the importance of evaluation in health programs is gaining attention. Perhaps this is in response to Moyo’s argument that $1 trillion in international aid has actually increased poverty and the shocking lack of evidence to the contrary. Last fall, I attended a lecture by Richard Horton, Editor of the Lancet, at which he urged the global health community of Seattle to use their expertise to support critical evaluation of global health data. President Obama’s recently announced Global Health Initiative highlights the need for robust monitoring and evaluation efforts in order to accelerate best practices and impact. Furthermore, donor communities are increasingly demanding evidence of impact from the organizations they support. With increasing attention on the importance of evaluation, the global health community is turning their efforts to the improvement of metrics, data, and evidence.

Barriers to the evaluation of global health programs are not insignificant. Evaluations are expensive, time consuming and highly political. For one thing, donors typically want their contributions to go to strengthening a health program rather than to a study of it. Furthermore, many government and non-government organizations fear finding evidence that their programs are not successful and potentially lose funding. Despite the difficulty, expense, and potential for undesirable results, conducting rigorous evaluations of our programs is one of the most valuable things we can do. Only with evidence can we attempt to answer the question of “does it work?”

-Jessica Crawford

Program Associate

“In my opinion, the weakest link in the chain now is the in-country distribution system. The costs of ignoring this key part of the health system can be extremely high.  A key reason for the poor performance of the in-country supply distribution system is the lack of an institutional and governance framework on how to organize in-country distribution.”

With keen insight, Professor Yadav articulates the challenges VillageReach faces daily in creating sustainable systems for the delivery of basic, life saving supplies. In addition to this article, Global Health Magazine posted a blog just a few days ago challenging various health system misconceptions.  The article challenges some widely held assumptions, many of which VillageReach has heard repeatedly over the years from potential donors and partners:

• Health systems can’t be measured.
• We don’t know what works to strengthen health systems.
• Strengthening health systems will be a money pit, an expensive, open-ended investment that won’t show measurable results.

Challenging these statements, the article cites the availability of measurable and proven methods within health systems, which can allow practitioners to make vital decisions. We were excited to see these acknowledgments, as a cornerstone of the methodology at VillageReach is the measurement and evaluation of our programs, and through our rigorous evaluation we have proven that health system strengthening programs can not only result in measurable impact but impact that tangibly saves lives.  We hope that these publications represent a shift of perspective within the world of Global Health towards a new view that will see “last mile” health delivery systems as a critical piece of the larger picture.

Ultimately, what role does social media play in promoting the work of NGOs?

My name is Alexa and I am first year college student currently volunteering for VillageReach.  I have spent the last week researching different blog sites maintained by practitioners (examples researched include The Acumen Fund and Frontline SMS), research centers (The Center for Global Development), foundations (The Skoll Foundation), academic blogging vehicles (The Stanford Social Innovation Review and The Duke Sanford School of Public Policy), donor communities (GiveWell and Tactical Philanthropy) and independent blogging sites (Good Intentions are Not Enough and Blood and Milk).  The purpose of this research was to identify online communities where VillageReach could engage with practitioners, researchers and donors, raise awareness of VillageReach and network with different organizations and individuals.

I found it compelling to learn more about how different organizations and individuals utilize blogs to promote new ideas, engage with their donors, make announcements and network.  Additionally, some of the most successful non-profits have revolutionized the new social media/network space for fundraising and to create awareness. For example, Kiva’s and Heifer International’s on-line models parallel a function offered by Facebook.  In its configuration, sending a friend a birthday gift of a goat graphic over Facebook does not differ greatly from giving a goat in the name of a friend through Heifer International. Kiva draws its strength through an emotional connection a donor draws through a photo of a recipient and through lender groups. The ever evolving web has changed the rules of the game when it comes to how non-profits structure their models, raise awareness of their cause and fundraise.

My research has guided me to raise several questions on how VillageReach should further engage and connect with other organizations, individuals and donors through the web as well as how other organizations view the web/social media as a tool for their overall mission.

1.)   How has your NGO modified their marketing/communications approach to engage in online opportunities and culture as well as to establish a social media presence?

2.)    What role do social networking sites such as Facebook/Facebook causes play in the work of NGOs?

3.)    How can the blogosphere help to unite fragmented divisions such as public/private sectors, multi-lateral sectors and NGOs?

4.)    Many non-profits such as Oxfam, Charity:Water and Amnesty International, etc. offer opportunities and resources for high school and college aged students to become informed on issues pertaining to poverty and human rights, to take action for a cause and to fundraise on behalf of the NGO.  What role should youth play in VillageReach’s mission/work?

Certainly this concept is not new as non-profits flood their year-end marketing appeals with individual sponsorship programs and passionate stories of hardship and suffering. Kiva is a perfect example of the power of connecting to the individual as they market to donors with a personalized story and photo of each borrower.  So what is our debate about you ask? The question in the office is: If this type of marketing works, and research shows that it does, shouldn’t VillageReach change its message to focus more on individual stories and less about systems?

Up until now, VillageReach has presented its message and for that matter, our brand, as a social enterprise. We are capacity builders and have been recognized as one of the top non-profits for our cost effectiveness in strengthening healthcare systems.  Our work directly impacts those children who so successfully appeal to donors. Yet, this is our challenge. If we focus on the child who we are able to save through immunization, do we lose the opportunity to educate donors on the critical importance of systems building and social change? Do we lose the chance to describe the complicated and sophisticated nature of what we do?

Perhaps this is not black or white and just as any good fund development or marketing manager knows, you need different messages for different audiences. Yet, Professor Singer’s book has given us an opportunity to step back and discuss how we tell our story to current and potential donors.  And wherever we land at the end of this debate, we know either way the most important message of all is in our ability to save a life. That we all agree on. What are your thoughts?  Join us in this debate.

The workshop highlighted inadequacies of the cold chain in addressing the government’s immunization goals, critical gaps in energy, communications, and transportation infrastructure that exist for many last mile communities; and that health workers are overburdened due to the scope and scale of their day-to-day work.  Not surprisingly, our experiences in sub-Saharan Africa are addressing these same issues.

How did we get from rural to urban?  As part of the workshop we included discussions on India’s population growth and industrial development that is leaving millions behind in rural communities throughout the country.   The three states of Bihar, Madhya Pradesh and Uttar Pradesh make up over 50% of the country’s estimated 10 million unimmunized children.  That’s the largest unprotected population of any one country on the globe. The great majority of theses states’ children are the very rural poor.   But two of these states also have the highest child mortality rates for urban poor communities in the country, which highlights the correlation between the rural poor and the rapid urbanization of the country, as desperate migrating families look for employment.  Dr. Siddharth Agarwal of the Urban Health Resource Centre, based in Dehli, is a passionate and persuasive advocate for these urban slum communities.

Not unlike remote rural communities, urban slum populations are difficult to reach.  There is weak physical infrastructure, limited reliable health services and poor documentation of the populations.

The plight of India’s city slum dwellers certainly isn’t a new topic … Mumbai’s Dharavi Slum of “Slumdog Millionaire” fame helped ensure that, but that the task of improving last mile healthcare access for the urban underserved is strikingly similar to that of rural communities, certainly may be.

I am excited about the potential that these two projects will have for those working in rural and remote areas with poor road and electricity infrastructure and for us, who will be able to collect real-time information about what the needs are in the field and how we can develop programs and innovative approaches to strengthen health systems at the last mile.

Although my time in Malawi was quite busy, I was glad to have had the chance to visit an under-5 clinic, where large numbers of women brought their children to be weighed (for growth monitoring purposes) and to be immunized. In Malawi, like in most of the world, women spend their days collecting water and firewood, washing clothes, caring for handfuls of children, tending to their fields, and preparing meals. Yet these women were willing to put their other duties on hold so that their children could receive vaccines and have a chance at growing up healthy. The health workers in Kwitanda have done a great job at educating these women about the importance of vaccines and health care for their children.

-Jessica, Logistics Manager

As we move forward into fall, we look forward to even more good news…

Each year, the Tech Awards recognizes 15 global innovators who apply technology to the most critical issues affecting the world.  This year, VillageReach was selected from among hundreds of nominations representing 66 countries.  The Laureates are honored at a gala in San Jose in November.

VillageReach’s Management Information System (vrMIS) was recognized because of the significant impact it made in improving information and decision making in VillageReach’s Mozambique program.  Developing countries bear the greatest burden of infectious diseases, but they often have poor infrastructure to support critical public health programs.  VillageReach worked with the government of Mozambique to implement vrMIS which enabled health workers in the field to send and receive data in real time and as a result, empowered health workers to make the best possible decisions based on accurate and timely information.

VidaGas was started in 2002 to support the health system improvement program developed by VillageReach and FDC.  More than 80% of Mozambique’s population is rural and depends on charcoal and wood for basic cooking and heating.  Safe and reliable propane from VidaGas enables health centers to provide critical health services including vaccinations, equipment sterilization and nighttime birthing.  Additionally, propane from VidaGas is a clean and affordable alternative to charcoal and wood for households, small businesses, and light industry clients.  VidaGas has grown over 500% since 2002 and is now the largest propane distributor in northern Mozambique.

Oasis Fund is a Luxembourg investment fund which finances innovative, growth stage, commercially viable enterprises that deliver basic goods and services that improve the lives of low-income communities.  This investment is the first investment in Africa for the Oasis Fund.  Oasis Fund is advised by Bamboo Finance, a Geneva based investment advisory firm.

VillageReach’s Social Business Director, Craig Nakagawa, will be speaking with Keely Stevenson, of Bamboo Finance, about the investment at SoCap tomorrow.