Year founded: 2000
Geographic reach: Sub-Saharan Africa; headquarters in Seattle (USA)
Annual budget: $12 million (Fiscal year 2017)
Number of employees: 110 (2017)
VillageReach, a health systems-strengthening organization, works at the “last mile” of public healthcare, bringing innovative solutions to the challenge of reaching the most underserved communities in the world. VillageReach develops, tests, implements and scales new systems, technologies and programmes that improve health outcomes by extending the reach and enhancing the quality of healthcare. Its solutions address barriers in access, such as the accessibility of healthcare, constraints in human resources, the availability of information and inadequate infrastructure. VillageReach currently has projects in nine countries, with operations impacting over 11 million people.
Blaise Judja-Sato, a native of Cameroon, left his job as a telecommunications executive in 1999 to volunteer with Graça Machel’s Fundação para o Desenvolvimento da Comunidade (Foundation for Community Development [FDC]) in Mozambique after the country’s devastating floods. Through this experience, Judja-Sato became aware of the immense challenges of delivering aid to Mozambique’s most remote and rural populations. In response, he founded VillageReach in 2000 to address these barriers to healthcare delivery in underserved communities.
In 2003, VillageReach, FDC and the Mozambican Ministry of Health (MISAU) began the Dedicated Logistics System (DLS) initiative to redesign the vaccine supply chain from scratch. It brought together improvements in human resourcing, transportation, cold chain and logistics management information to reliably enhance the uptake and effectiveness of childhood immunizations. A rigorous evaluation revealed that by the end of the project, stockouts of vaccines had decreased from 80% to less than 1%, and the proportion of children receiving the full treatment of vaccines had increased from 68% to over 95%, all at a 20% reduction in the cost of operating the vaccine supply chain.
With this successful intervention, and with the support of other donors, VillageReach embarked on a series of additional innovations, including a mobile health platform (Health Centre by Phone) in Malawi and an open source logistics management information system (OpenLMIS) implemented in Mozambique, Tanzania, Zambia, Benin and Côte d’Ivoire. Today, VillageReach operates a portfolio of innovations dedicated to serving and improving uptake at the last mile.
Figure 5: Methodology
Source: VillageReach, Rivers of Change, December 2015, Presentation
How VillageReach works
Through years of field-based work using systems innovations to improve access to quality healthcare, and working with global partners to advocate for their adoption, VillageReach has developed a four-step methodology for change (Figure 5):
- Learn is the stage where VillageReach spends time in the field with communities and health workers to understand their needs and desires, as well as their challenges.
- Develop involves the testing, measuring, refining and proving of a new approach to determine whether the innovation should be taken to scale. During this time, VillageReach typically operates at a small scale over a limited period of time, in partnership with local health system authorities in order to exert direct influence over the work.
- Promote includes using the evidence base to advocate for ministries of health, as well as their donors and public health partners, to adopt and absorb the systems innovation. VillageReach considers this to be the most difficult and time-consuming step because it relies on relationships, advocacy and policy development.
- Support is when VilllageReach is asked to help ministries of health and their public health partners as they scale and sustain the systems innovation. From the promote stage onward, VillageReach uses indirect influence to encourage and help larger institutions improve access to quality healthcare for populations. This greatly exceeds what VillageReach could address on its own.
VillageReach works inside public health systems, designing programmes and applying technology that extend the reach of healthcare to underserved communities, primarily in rural, hard-to-reach locations. The organization’s four-step process works to maximize scale and sustainability by transitioning its innovations to government-led operations, providing support to ensure quality and continuous improvement.
The organization’s flagship programme is the DLS, a project to redesign Mozambique’s vaccine supply chain. Rather than make incremental improvements, VillageReach decided at the outset to redesign the entire chain. Prior to the DLS, vaccines were delivered from the national storehouse to those in provinces and districts, but the final trip – from district to clinic – required clinic staff to take time off to retrieve vaccines. During these trips, staff would close their clinic and use their own funds to take public transport to pick up the vaccines. If clinic staff were unable to front the transport fees to collect vaccines, clinics would experience a stockout and be unable to vaccinate patients. Furthermore, staff were often not trained in vaccine storage and transport, and vaccine supplies were frequently compromised by lack of reliable transport or faulty clinical equipment for cold storage. In the province where VillageReach piloted the DLS, stockouts were experienced 80% of the time, and more than 30% of children did not receive the full treatment of vaccines.
VillageReach’s primary change was to introduce a new, full-time field-level role – the field coordinator –responsible for vaccine delivery, data collection and routine maintenance of cold storage equipment. By adding a new cadre of worker, the DLS addressed one of the system’s primary bottlenecks: the lack of accountability. Additionally, the DLS introduced routine data collection through an open source, web-based logistics platform that provided data visibility and access. Finally, the DLS allowed for better transport options, including third-party transport from the private sector to augment the use of government vehicles.
A rigorous evaluation showed a significant increase in routine vaccine coverage in the province during the intervention.1 With urging from MISAU and the infusion of unrestricted funding, VillageReach pushed the DLS towards national scale; over three years, the organization began to roll out the DLS to three additional provinces in Mozambique. Building on this and a deeper understanding of the challenges on the ground and for a multidisciplinary team, VillageReach now creates and validates new, high-impact solutions. It then mobilizes multiple partners at the global, national and local levels to implement and sustain them for more effective and efficient healthcare delivery support services at scale.
Systems change requires holistic, rather than incremental, interventions
VillageReach looks at processes and systems holistically, rather than trying to create incremental improvements. For the DLS, the primary bottleneck was that responsibility for vaccine delivery from district to clinic was too dispersed to ensure accountability. By introducing a skilled, field-level coordinator, the DLS reduced the cost per dose while decreasing stockouts by nearly 80%.
Systems leadership is about learning and teaching
VillageReach works in partnership with ministries of health, ensuring that innovations are meeting decision-makers’ critical needs and priorities. The organization then aligns its evaluations to ensure that evidence supports these priorities. VillageReach also works to ensure it innovations are in line with national and local policies, such as procurement and staffing protocols that may impact implementation.
Questions for social entrepreneurs
- What is your organization currently learning about the system in which you are operating? How are you sharing that learning with other actors in the system?
- Is your staff prepared and capable to teach other individuals and organizations how to do your work? If not, what new staff or skills do you need to acquire as an organization?
“It’s possible that VillageReach could raise additional funds and expand its footprint to provide those benefits to additional children over a longer time period. But given the sheer size of the challenge represented by providing vaccine access to all children in perpetuity, it is simply impossible for VillageReach to address that challenge absent of a coordinated, collective approach by many partners, including large global health institutions and governments.”
Allen Wilcox, Member of the Board and Adviser, VillageReach