Feature December 2003-January 2004 Part 2
VillageReach -- The last mile is just as important as the first
When children at a clinic on the outskirts of Maputo, Mozambique lined up to receive the first immunizations made possible by theGlobal Alliance for Vaccines and Immunization (GAVI) in 2001, many of the major players in the new collaboration were on hand to witness this milestone event: William H. Gates, Sr., of the Bill & Melinda Gates Foundation, Carol Bellamy of UNICEF, Mozambique President Joaquim Chissano and Graça Machel, Chair of Mozambique's Foundation for Community Development (FDC).
Also on the scene was a lesser known, but no less essential partner in the effort to provide lifesaving vaccines to children -- Blaise Judja-Sato, a social entrepreneur determined to use his business acumen to create the critical linkages between those funding and rolling out the vaccines, and the hardest-to-reach end users in rural Mozambique.
As Judja-Sato, a former telecommunications executive knew, getting the vaccines to a capital city such as Maputo was one thing, but delivering them to the "last mile" -- the most remote villages in Mozambique -- was a challenge of a different order. In many of these communities, clinics were unable to properly store and safely administer the vaccines, even if they could get them. When refrigerators broke down, vaccines spoiled. For want of a spare part, children were dying.
"It costs about five times more to reach those remote communities than it does to get vaccines to urban centers like Maputo," said Judja-Sato in a recent interview with Global Giving Matters. "It's so demanding resource-wise, that many people have simply given up on the healthcare system in Mozambique," especially in outlying areas where infrastructure -- medical and otherwise -- is rudimentary at best.
A new model for delivery of critical supplies
In response to the situation on the ground in Mozambique, Judja-Sato in 2000 founded a nonprofit organization, VillageReach (www.villagereach.org), to find sustainable solutions to the logistical problems of healthcare delivery in the developing world. Early support for a promising model to improve the supply chain in Mozambique came from the Children's Vaccine Program (CVP), the first of the new-style vaccine alliances forged by the Bill & Melinda Gates Foundation with the Program for Appropriate Technology in Health (PATH). A forerunner of GAVI, PATH/CVP provided $300,000 for a feasibility study. Further validation came from PATH/CVP in the form of another $425,000 to develop a demonstration project based on that model.
When Bill Gates looked at the problem of global immunization rates, he diagnosed a market failure on the research and development side and set about addressing it with new alliances such as PATH/CVP and GAVI. Judja-Sato brought a similar business approach to bear on the distribution side of the equation to get those newly available vaccines to the people who needed them. Further, he found that he could use immunization as a platform to build infrastructure that could be used for a variety of essential supply problems in the developing world.
On several levels, the influence of the Gates Foundation has provided important support for the work of VillageReach, Judja-Sato says. "The Gates Foundation allowed new ways of looking at problems to be discovered and piloted. Bill Gates made possible an environment where people like us could come to the table and propose new models. Funding is a critical part of it, but they've also been amazing advocates and have shaped the agenda for vaccine development."
To get the pilot project up and running and win government support, VillageReach also needed strong and reliable local partners in Mozambique, and the Foundation for Community Development offered a good fit. healthcare, especially in underserved rural areas, was a priority for FDC, which is a partner of The Synergos Institute. And a relationship of mutual trust and respect had grown up between Graça Machel and Judja-Sato as a result of his active fundraising for FDC and his work in Mozambique delivering resources he had mobilized for flood victims.
VillageReach also found a powerful backer in the national government, whose commitment to healthcare made Mozambique the first applicant to receive vaccines under GAVI's incentive-based investment model, which provides support based on a country's demonstrated ability to deliver results. In March 2002, VillageReach and its primary partner FDC signed a five-year contract with the Ministry of Health (MOH) to increase efficiency in the healthcare system of northern Cabo Delgado province, chosen on the basis of need. By July, Judja-Sato was making the first deliveries of vaccines and other supplies to the country's most remote outposts.
Up and running in Cabo Delgado
The VillageReach "fleet"-- at this writing, three trucks, and several motorcycles-is becoming an increasingly familiar sight on the dirt roads of Cabo Delgado, clocking thousands of miles a month as it makes its delivery rounds. A major focus is the supply and maintenance of the "cold-chain", the refrigeration system that keeps the vaccines viable, but VillageReach also delivers other medical supplies and equipment, information and training. VillageReach is also working with the Ministry of Health to extend the outreach of clinic staff by providing them with bicycles.
"Think of us as UPS-plus," said Judja-Sato, referring to the global shipping company. "We ensure timely delivery and we maintain the equipment and train health workers."
Under the partnership forged by VillageReach, the Ministry of Health buys the vaccines and medical supplies and builds and staffs the rural clinics. FDC provides additional funding for the project and manages the relationship with the government. It also educates communities about the project and enlists local leaders in support of the project, to create buy-in at the village level and a demand for higher quality healthcare services. Without this kind of empowerment at the community level, modern healthcare will remain unavailable to the vast majority of those living in remote corners of the developing world, Judja Sato believes.
The contract with VillageReach represents the first time that the MOH has outsourced delivery of critical vaccines and medical supplies. A standard practice in many developed countries, the outsourcing of health logistics is rare in the developing world because of the lack of reliable companies to do the work. The Ministry's decision to turn this work over to VillageReach reflects confidence that this unique public-private partnership can serve remote communities in a way that is cost-effective and sustainable.
Building a relationship of trust
Based on the results to date, this trust seems well placed. According to MOH estimates, VillageReach has increased voluntary immunization rates of participating districts by up to 40 percent in its first year of operation there-a critically needed boost in a region where only 29 percent of infants are receiving full immunization. Such statistics suggest that the changes brought by VillageReach -- regular supplies of vaccines and other essential medicines and new, reliable refrigerators -- are quickly building confidence in the national healthcare system, a key goal of Judja-Sato and FDC. The pilot project, which began by supplying 22 clinics, has expanded to reach more than 40 health facilities serving 900,000 people.
"VillageReach is strengthening communities and most importantly, saving lives," says Graça Machel, who in addition to her leadership of FDC, chairs GAVI's financing arm, the Vaccine Fund. "We have these amazing life saving vaccines and medicines, yet they cannot help if they fail to reach the children and families who need them most."
By design, the scope of Judja-Sato's vision for VillageReach extends beyond healthcare to a broader development context. Spurred by the prohibitive expense of reaching its rural "customers," the model includes an income-generating component that helps subsidize project costs and provides a range of sustainable benefits to the local economy. "We want to help preserve the long-term economic vitality of the region," says Judja-Sato. To accomplish this aim, VillageReach and FDC have launched a Mozambican for-profit company, VidaGas, with its own distribution plant in Pemba, the main town of Cabo Delgado.
VidaGas sells its clean-burning liquefied petroleum gas (LPG), also known as propane, to the MOH to power essential equipment in health facilities such as refrigerators, sterilizers, and lamps, and is starting to sell gas commercially to households and small local businesses such as restaurants and hotels. Beyond the profits that will be realized by VidaGas sales and will be put back into the non-profit health venture, Judja-Sato sees a far-reaching range of benefits, from reduction in respiratory ailments as households move away from wood and kerosene fires, to protection of environmentally sensitive mangrove swamps, now a primary source of fuel. VillageReach is also working with local entrepreneurs such as fishermen's cooperatives and cashew farmers and processors, to improve profitability by incorporating propane into their operations.
Rewards of partnership in Mozambique
"When I look at what we've done, it's amazing that we've actually been able to set up a system that impacts so many in such a short time," says Judja-Sato, who was born in Cameroon and was active in philanthropy on behalf of his home continent before founding VillageReach, as a board member of the Seattle branch of UNICEF, as a trustee of the Africa-America Institute, and as the president of the US branch of the Nelson Mandela Foundation.
He says the level of intensity of his work with VillageReach has been much greater than he ever experienced in the for-profit sector, where he was a successful telecommunications executive. At AT&T, he helped build undersea fiber optics systems in Europe and Africa. The job he gave up for VillageReach was a position as director of international business development at Teledesic, the Seattle-based satellite broadband company co-founded by technology leaders Bill Gates and Craig McCaw.
While the challenges he faces in Mozambique are daunting, Judja-Sato says the rewards are unparalleled. "When I go out into the field in a delivery truck and see how excited the health workers are, or how warmly I am greeted by the governor of the province, it has touched me more than signing a deal for some commercial product ever could."
At every turn, Judja-Sato says, partnerships and relationships of trust have been critical to the success of VillageReach. It is his skill in forming and nurturing these strategic alliances that will be the key to making the programs of VillageReach self-sustaining in the long run. Recently, for example, he has teamed up with the Mozambique National Energy Fund (FUNAE) to encourage families and businesses to adopt propane as a primary fuel source. Plans are underway to work with microlenders to establish programs to help households buy the stoves and lamps that run on LPG fuel.
VillageReach is also tapping in-kind contributions from businesses such as Amerigas, the largest propane distributor in the US, which is donating cylinders and trucks, Iridium, a global satellite company helping with communications services, and Getty Images, the world's leading imagery company, which is providing technical assistance and office space in Seattle.
Validating and expanding the model
Support sometimes comes from unexpected quarters, such as the 12-year old son of a donor who offered to design a brochure for VillageReach as part of the tradition of doing service for his bar mitzvah, the Jewish coming-of-age ceremony. In addition to contributing design services, he convinced his friends to write checks to VillageReach rather than giving him gifts for his big day and raised $16,000 for the organization.
As word of Judja-Sato's model spreads, VillageReach is receiving important new financial support and validation from other major funders. In December, the World Bank announced that VillageReach was a winner of its 2003 Development Marketplace competition, which carries a $250,000 award and provides a range of valuable technical assistance to successful applicants. (Judja-Sato notes that the brochure designed by the young supporter was submitted as part of the winning application.)
The visibility and financial support conferred by World Bank recognition will be key to helping VillageReach expand, and eventually, replicate its model. "It's tempting to expand to other countries, but we want to go slowly so we can provide a refined model that ensures that existing vaccines, and future vaccines against diseases such as malaria, tuberculosis, and HIV/AIDS, reach the people for whom they are intended," says Judja-Sato, who estimates that the project will be ready to move into other countries by the end of 2004. In the meantime, he is concentrating on getting the program's services out to some five million Mozambicans over the life of the five-year contract with the MOH.
Judja-Sato reasons that if VillageReach can succeed in the demanding conditions of Cabo Delgado province, "we will prove that we can do this anywhere." Others obviously are thinking along the same lines -- he has been approached by representatives from 10 other countries about adapting the VillageReach model to make those vital connections to their own last mile.
Back to Part 1: A conversation with Patty Stonesifer
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