For nearly ten years, VillageReach’s health systems strengthening programs have maintained a clear focus on the last mile healthcare access. Our approach focuses on the logistics of medical supply and service delivery to increase reliable access to healthcare in the poorest, most remote locations. We work directly with government agencies and local partners to ensure sustainability by designing systems that can be integrated into the regular operations of the public health system. VillageReach currently has field programs in Mozambique, Malawi and Senegal.

Logistics at the Last Mile

VillageReach believes that existing health systems can be radically improved by strengthening the final segment of the supply distribution system. Last mile health systems often have inefficient and under-resourced basic support systems that result in erratic delivery of essential medical commodities to rural health centers. By applying basic logistics and supply chain management practices and tools in support of the health system, VillageReach increases access to, trust in, and quality of last mile healthcare.

VillageReach’s programs establish and implement a logistics system dedicated exclusively to the health system. Along with the delivery of medical supplies, this logistic system also creates a platform to deliver crucial health services such as health worker training and supportive supervision to health centers.

VillageReach’s field programs seek to accomplish the following goals:

• Regularly and reliably distribute vaccines, gas, essential medicines and other medical supplies
• Monitor and supervise the logistic process
• Strengthen the technical capabilities of rural health workers by supporting their training, including training on maintenance of the cold chain, data analysis, drug forecasting and procurement, maintenance and repair of critical equipment and safe injection and waste disposal practice
• Establish a communication system for coordination and emergency response in the health facilities
• Strengthen the management capacity of district and provincial health system staff
• Strengthen the health information system

An efficient logistics system not only ensures that appropriate, high quality medicine and vaccines are available to those who need them most, but it also allows health workers to focus on provision of care for the community rather than logistics. A recent analysis of the VillageReach model in Mozambique found that in comparison to the ad hoc logistics system which is the default in most low-resource countries, VillageReach’s dedicated logistics system frees up 216 days of staff time per month, allowing for significant improvements in health worker productivity by removing unproductive time spent on vaccine logistics.

VillageReach’s Value and Approach

Tools and Services

VillageReach’s field programs utilize a set of proven tools and services to strengthen health systems that serve under-privileged communities.

• New Program Landscape Analysis background research and analysis performed by VillageReach before designing program.
• New Program Assessment is an in-country evaluation of the health system, especially logistics and infrastructure analysis, and production of an evaluation detailing estimated costs, duration, and activities of a new program.
• Training Materials are produced for in-country staff detailing their roles and responsibilities.
• Final Evaluation is an assessment measuring the impact of VillageReach’s project including effect on staff, patients, costs, and health system indicators. Includes statistical analysis of all data collected.
• On-going Monitoring and Reporting provides supportive supervision for health system workers and tools to report and monitor data.
• Logistics System Cost Study is a comprehensive model developed by VillageReach used to understand cost breakdown of health system services and to measure the impact of VillageReach’s program as compared to baseline estimates taken at the start of the program.
• VillageReach engages through consulting services, outsourcing and creation of its own programs.

CASE STUDY: CABO DELGADO PILOT PROJECT

In 2002, VillageReach began a five-year program to improve the vaccine system in the Cabo Delgado province of Mozambique.  An independent impact evaluation found that the VillageReach model:

• Increased coverage rates from 69% to 95%
• Decreased stockouts of vaccines from 80% to 1%.
• Increased confidence in the health system- over 90% of families had visited a health center in the previous month despite half of them living over two hours away.
• An absolute cost savings over the default distribution system ($364,104 compared to $468,701 per year).
• Significantly increased cost efficiency over the default distribution system as measured in cost per child vaccinated with DPT-Hep B3 ($5.76 compared to $10.36 per child).