VillageReach: Servicing Africa’s “Last Mile”

When Blaise Judja-Sato, a successful Seattle-based telecommunications executive originally from Cameroon met international human rights advocate, Mrs. Graça Machel, (the wife of the late Nelson Mandela and former first lady of Mozambique and South Africa), his life was forever changed. Inspired by Mrs. Machel to make a difference, he left his job in 1999 to volunteer with Graça Machel’s Foundation for Community Development [FDC]) in Mozambique to help support relief efforts after the country’s devastating floods in 1999.  While working on relief efforts, he was struck by the tremendous challenges to deliver aid to the places that needed it most.

While aid was readily available in Mozambique’s capital city, the systems that were required to deliver aid to those remote, rural populations were grossly inadequate and ineffective.

Upon his return to the United States in 2000, Judja-Sato formed a small group of logistics and public health advisers and established the non-profit, VillageReach with the intention to address the challenge of healthcare delivery to those in remote and rural communities — those at the “last mile.”  Judja-Sato and his advisors built a foundation from which VillageReach has achieved significant impact at the last mile; increasing access to quality healthcare in some of the world’s most underserved communities.Today the non-profit, headquartered in Seattle, has approximately 130 employees with active programs and projects in multiple countries including Mozambique, Malawi, Benin, DRC, Tanzania, Togo, Pakistan and Zambia. Wanting to learn more about this non-profit we had a chance to talk to their Communications Manager, Sandy Hawley.What makes VillageReach unique?We are a bit of a hybrid – bringing together expertise across public health, technology and the private sector to develop a wide range of innovations that increase access to healthcare at the last mile. This diverse combination of skills and experience, together with a strong commitment to locally-grown innovation and partnership is essential to our mission. Describe the “Last Mile.”  The “last mile” is actually a telecom term referring to the final leg of telecommunications networks that deliver services to end-users. It has since evolved in the global development context to refer the final point in which healthcare services are accessed, typically the most rural, hardest to reach communities. In these communities, basic access to healthcare can be a significant challenge. Distance is a key factor. Many people live far away from the nearest health center — sometimes walking miles and traveling hours to access care.  A shortage of trained health workers makes it difficult to adequately serve the populations who depend on them. Essential medicines, vaccines and other critical health products are often stocked out due to poor infrastructure and/or ineffective health supply chains. These are issues that can’t be solved with one single solution. It takes a holistic approach and many interventions working together to strengthen the health system and increase access to quality healthcare.

VillageReach develops and implements new systems, technologies and programs that increase the capacity and reach of health systems starting at the last mile.

How do you choose which communities and countries to address?  Because we work closely with partners, relationships are key to our geographic focus. We prioritize based on where we have the strongest partnerships and opportunities for collaboration, and where VillageReach’s last mile expertise can help ministries of health achieve their goals to increase access to quality healthcare.How does one get involved with VillageReach?There are many ways to get involved; helping to increase awareness, contributing financial or in-kind support and volunteering. Our website is a great resource to learn more about ways to give and get involved.One of the ways VillageReach is sustainable is through donor funding. Where does most of this come from, and how else is VillageReach able to provide the services that it does?Grants make up a large part of our funding, however, individual donors are a critical source of funds when it comes to developing new innovation. Donors also provide sustaining funds to advance successful programs. Corporate and private sector partners often provide the resources required to take an innovation far beyond what VillageReach, its donors or the local government could do alone.In order to make long-term change you partner with other programs to determine how interventions can be sustained, what are some of the partners you work with and how have they helped?One of the best examples of partnership is the mobile health hotline Chipatala cha pa Foni (CCPF), or “Health Center by Phone.”  CCPF is a toll-free health hotline in Malawi staffed by trained health workers who provide information, advice and referrals over the phone on all health topics. Through CCPF, women and caregivers can also sign up to receive personal text or voice reminders on maternal and child health topics specific to their month of pregnancy or their child’s age. CCPF is accessible by more than 5 million people and is in the process of becoming a national service, fully run by the government. Several donors and partners contributed to the success of CCPF, helping to develop the technology, content and model. Working closely with the Malawi Ministry of Health from the beginning was critical to success as well as an innovative public-private partnership with the leading mobile network operator in Malawi, Airtel. Through this partnership, Airtel essentially donates the airtime that was previously paid for by VillageReach and its donors. This support was critical to ensure that the service remain free to users and could be sustained by the government. This partnership is a pioneering example of how the private sector can work with civil society to improve public health, especially in low and middle income countries where limited resources can prevent innovation and high-impact programs from reaching their full potential.In addition to CCPF, what are some other programs that VillageReach has set up?  In many cases, it’s not a “program” per se, but rather a new approach. VillageReach’s earliest work focused on a new approach to redesign and the improvement of the vaccine supply chain in Mozambique resulting in significant increases in fully vaccinated children, dramatic reduction in stock-outs and reduced costs.

Today, VillageReach is working with ministries of health in multiple countries to adapt the principles of “next-generation” supply chains to ensure more effective and efficient delivery of vaccines and other essential medicines to some of the most difficult to reach communities.

In what ways do you provide long-term help for health workers?  It’s less about providing help for health workers, and more about building capacity from the last mile up. We focus on solutions that ensure health workers have reliable access to the tools, support and resources they need to provide quality healthcare. Working collaboratively with governments and local communities is essential to developing sustainable solutions that create lasting change. The Pharmacy Assistant Training Program is a great example of our work in this area.Tell me about a typical day at one of the locations. Many of our staff live and work at the “last mile” so they know firsthand what is working and what isn’t. They are at the clinic, talking with health workers and patients. They are also working side-by-side with our ministry of health partners at the higher levels of the health system to bring that last mile perspective to planning, development and implementation of new programs.Describe a typical day at headquarters in Seattle.A public health expert, a software engineer and a private sector logistics specialist are having a conference call with our Malawi team to discuss current challenges and ideas to improve availability of reproductive health products at the last mile.What are some of your favorite success stories that have come from VillageReach? When scale-up is complete, CCPF will be the first national, government-run health hotline in Africa. This is a major achievement not only for a non-profit, but also within the global digital health community. To be part of a “first” like this is a huge milestone for VillageReach and its partners.

Through VillageReach efforts, many more children in Mozambique are getting the life-saving vaccines they need because the supply chains are more efficient and effective in reaching the last mile.

We are now building off of this work to address other health commodities beyond vaccines (like HIV medicines), and also to explore how technologies like unmanned aerial vehicles (UAVs) might play a role to improve transport of other health products at the last mile. One of the most interesting things about VillageReach is how programs continually adapt and build off one another. We are constantly learning. How has VillageReach personally enriched your life?  Having the opportunity to visit our country offices and learn from members of our team who have such diverse areas of expertise is incredibly enriching. To see the impact of our work firsthand is inspiring. On a recent trip to Malawi, I had the opportunity to visit several rural villages. I talked with mothers who shared stories about how the mobile health hotline CCPF has been a vital healthcare resource for their family. We all want our children to be healthy and safe. As a mother, it is this mutual understanding that for me, provides a very meaningful and personal connection to the work.*Photos by: Paul Joseph Brown.