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The Global Challenge

The Global Challenge Critical health logistics systems are poorly maintained, in advanced states of decay or altogether absent Weak managerial skills, poor motivation of staff, and unpredictable funding for health services

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The Global Challenge

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  1. The Global Challenge • Critical health logistics systems are poorly maintained, in advanced states of decay or altogether absent • Weak managerial skills, poor motivation of staff, and unpredictable funding for health services • Lack of reliable fuel prevents proper refrigeration, sterilization and lighting in clinics • The poor quality of health services and unreliable availability of supplies have decreased confidence in the health system: • Many of the 12 million children not immunized in Africa live in remote areas beyond the reach of health systems • At least 1.3 million deaths are attributed to unsafe injection practices • In Mozambique, less than five percent of rural poor uses the public health system for diarrheal diseases, a leading cause of death

  2. Historical Responses • “Vertical” approach to a disease –e.g., Polio –or a family of interventions – e.g., GAVI for childhood immunization • These efforts effectively mobilize resources to solve specific problems but tend to duplicate efforts of others • The cost of providing healthcare in remote communities is five times greater than in urban areas • New strategies are needed to cost effectively reach mothers and children in remote communities

  3. GLOBAL NATIONAL VILLAGE Procurement Testing & Approval Storage & Distribution Handling & Administration VaccineManufacturers Children &Mothers GAVI Partners Public Health System VillageReach & Partners Illustrative Example: Vaccines & Immunizations

  4. VillageReach • 501(c)(3) non-profit organization that goes the last mile to improve access to essential services in remote communities • VillageReach was founded in 2000 and has assembled a extensive network of partners and advisors • Board of Trustees include: • Nelson Mandela, Honorary Chair • Graca Machel, Chair, Foundation for Community Development (FDC) • Dr. Seth Berkeley, CEO, International AIDS Vaccine Initiative (IAVI) • Jacques-Francois Martin, President, Vaccine Fund • Dr. Paul Kleindorfer, Professor, The Wharton School of Business • Blaise Judja-Sato, Founder and President

  5. The VillageReach Model Innovative Partnerships Local Capacity & Ownership Sustained Funding Communication System Transport System Energy System Refrigeration System Quality & Safety Access to Essential Services in Remote Communities

  6. The Demonstration Project

  7. Demonstration Project–Strategic Objectives • Strengthen the public health system and improve access to immunization & other healthcare services • Empower healthcare workers to concentrate on providing health services by freeing them from the burdens of logistics activities • Increase confidence in public health systems through greater availability of health services and participation of community partners • Lower dependency on external funding by covering up to 25% of operating costs with profits from propane sales within 5 years • Increase the share of local households with access to clean burning energy for cooking and lighting • Refine the VillageReach Model and create guides for replication in other parts of the developing world

  8. Demonstration Project– Situation Analysis • Cabo Delgado is located 900 miles north of Maputo and has 1.5 million inhabitants with one of the lowest per capita incomes in Mozambique • All of the 90 clinics experienced frequent stock-outs of critical vaccines, medicines, fuel, and spare parts for equipment • Clinics don’t have access to energy source to properly refrigerate vaccines, sterilize syringes, and provide lighting for nighttime emergencies • Overworked and poorly trained health workers spend up to 50% of their time on logistics and equipment maintenance • 45% of the population leaves more than 10 km from the nearest clinic. Lack of communications and transport significantly undermines outreach and supervision activities • Less than 6% of the population has access to electricity. Mangroves are now widely harvested for fuel, endangering the local commercial fishing industry, one of the main sources of income

  9. Demonstration Project– Progress to Date • Launched in March 2002, the project currently covers 42 clinics in seven districts serving more than 900,000 people • Installed a dependable cold chain – five large capacity refrigerators at the provincial store and propane-powered refrigerators in 30 clinics • Built a reliable logistics system – a dedicated fleet performs monthly deliveries of vaccines, medical supplies, and propane to participating clinics • Enhanced lighting services in clinics – installed propane-powered lamps • Improved safety of injections – provided propane-powered burners and incorporating needle removers to facilitate disposal of Auto-Disable syringes • Trained more than 100 health workers and local staff to properly operate and maintain equipment installed in clinics • Provided health workers with transportation and communication to improve outreach and provide emergency care

  10. Demonstration Project–Progress to Date • Established VidaGas, a propane distribution company, to ensure reliable availability of clean energy in Cabo Delgado • We supply about five tons of propane a month to clinics, households and businesses. Profits will fund logistics system, helping to ensure long-term sustainability • We are currently working with the Mozambique Government and Energy Fund to improve access to clean energy by introducing: • fuel subsidies for low-income households • micro-lending programs • affordable domestic appliances • We have created employment opportunities and helped set up three independent propane retailers

  11. Next Steps • Short-Term – Refine the Model • Strengthen and expand the system to reach 90 clinics serving 1.5 million people in Cabo Delgado • Interim evaluation and model refinement • Expand the system to reach 130 clinics serving 3.5 million people into the neighboring province of Nampula • Final evaluation, model completion, and finding dissemination • Long-Term – Roll out the Model • In Mozambique and other parts of the developing world

  12. VidaGas Solutions for Health • Propane is a safe, cost-effective, and environmentally-friendly alternative to traditionally-used kerosene and biomass fuels. VidaGas provides clinics with: • propane-powered refrigerators that are highly efficient • lamps that provide bright, consistent clinic lighting for nighttime emergencies • steam sterilizers that ensure safe injection practices

  13. Refrigeration System Issue: Cold chains are in advanced state of decay. Old kerosene-powered refrigerators have frequent outages due to lack of fuel and spare parts. As a result, temperature-sensitive vaccines become ineffective. Our Solution: We introduced new propane (LPG) powered refrigerators in remote health facilities. These refrigerators are highly efficient and reliable, and have low temperature variability. We also trained health staff in regular operations and maintenance procedures.

  14. Unsafe Injection Issue: Unsafe injections can result in the transmission of blood-borne pathogens from patient-to-patient, and from patient-to-health worker. The community is at risk when injection equipment is not safely disposed. Our Solution: We introduced injection safety and waste disposal tools, technologies and best practices. We have also provided propane burners for steam sterilizers that ensure safe injection practices in areas with limited access to disposable syringes.

  15. Maternal and Child Health Issue: Childbirth is an unpredictable event, occurring anytime day or night. In areas without electricity, deliveries can be difficult by the flickering light of a torch or kerosene lamp. The majority of women deliver their babies at home under unhygienic conditions without trained assistance. Our Solution: We installed new propane-powered lamps in health facilities to provide bright, uninterrupted light for nighttime childbirth. We deliver birthing kits to clinics and traditional birth attendants to ensure sterilized conditions.

  16. VidaGas Solutions for Households Issue: In many areas, women and children spend many hours collecting firewood. In addition to posing a significant threat to the local environment, cooking over an open flame is associated with long-term respiratory illness. Our Solution: VidaGas promotes the use of small propane cookers for household use. The equipment is provided at a low initial investment through micro-lending programs.

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