VillageReach Skoll Awardee Profile

Organization Overview

Key Info

Social Entrepreneur Blaise Judja-Sato

Year Awarded 2006

Issue Area Addressed Health

Sub Issue Area Addressed Health Delivery

Countries Served Angola, Congo (Democratic Republic), Liberia, , , ,

Website http://www.villagereach.org

Twitter handle VillageReach

Facebook https://www.facebook.com/VillageReach.org

Youtube https://www.youtube.com/watch?v=zu005ZH zabc

About the Organization VillageReach is an international NGO with offices in the Democratic Republic of Congo (DRC), Malawi, Mozambique, and the US (Seattle). Through collaboration with public and private sector partners, VillageReach transforms health care delivery to reach everyone, bringing high-impact solutions to scale and sustainability. VillageReach develops solutions that improve equity and access to primary health care. This includes making sure products are available when and where they are needed and creating new pathways to deliver health care that meets the needs of the most under-reached. Radical collaboration with governments and the private sector strengthen VillageReach’s ability to scale and sustain these solutions. Effective solutions require a deep understanding of local health systems, a diverse set of skills and expertise, and strong, local relationships to achieve sustainable impact. VillageReach’s experience “two decades of working in low-resource communities in sub-Saharan and around the globe with a wide range of partners” has informed its focus on the areas that have the greatest potential for large-scale impact to improve health outcomes.

Impact

VillageReach’s work increases the availability of quality health care for more than 35 million people across sub-Saharan Africa. In Mozambique, VillageReach’s improved immunization logistics system reached 1,200 health centers in 2018, improving vaccine availability for roughly half the country. VillageReach is now advising the government to become system owners and expand the approach nationwide. VillageReach replicated this solution in the Democratic Republic of Congo, and has also begun integrating drones into DRC logistics systems. VillageReach works with Gavi and immunization partners to build transformative supply chain design into the plans and policies of Gavi-supported countries. OpenLMIS is an open source information system for tracking medicines and health products. OpenLMIS has been deployed to over 11,000 health centers across 11 geographies to optimize data timeliness and accuracy. VillageReach and the Malawi Ministry of Health have worked together to create CCPF Health Center by Phone, a free national health hotline which creates pathways to primary health care delivery for rural and hard to reach communities. The Malawi Ministry of Health considers CCPF a key piece of their national health system and has taken over ownership and operation of the solution.

Path to Scale

Adoption of Model in Public Systems Ministries of Health are the preferred path to scale for VillageReach innovations. VillageReach co-creates innovative health solutions, integrates successful solutions into health systems, and ensures governments and partners are prepared to sustain them. Social Entrepreneur

Born in Cameroon, Blaise Judja-Sato was a successful US businessman until a devastating flood in Mozambique prompted his return to Africa. While helping with relief efforts, he saw both the suffering of the rural poor and the frustration of nongovernmental organizations that could not get medicines across the “last mile” of remote country to those in need. He also realized that these last-mile barriers affected industries and others who might be willing to pay into a shared system that benefited everyone. So, in 2000, Blaise gave up a lucrative corporate career to found VillageReach to build this infrastructure and solve the last-mile logistical challenges that prevent healthcare from reaching rural Mozambique.

Blaise left the organization in 2008 to pursue other endeavors and founded the NGO, The Resilience Trust, in 2015. He did not remain active in the organization. When Blaise left in 2008, Allen Wilcox, a volunteer and Board member, stepped into the role of President, donating his salary and in fact donating his own personal wealth to help keep the organization alive during uncertain financial times. In July 2016, Allen transitioned out of his role as President but remains on the Board in a senior advisor role focused on partner relations, advocacy for change leadership and innovation for improving health system performance at the lower levels. Emily Bancroft, was promoted from Vice President to President in December 2017.

Prior to joining VillageReach, Emily worked with the International Training and Education Center on Health (I-TECH), Physicians for Human Rights, and NPower, a pioneering social enterprise focused on transforming the way nonprofits use technology to achieve their mission. Emily is a Clinical Instructor in the Department of Health Services at the University of Washington. She holds an MPH from the University of Washington School of Public Health and a BA from Princeton University.

Equilibrium Overview

Current Equilibrium

The world’s collective health systems currently fall far short of providing access to quality healthcare for all communities over time. Quality healthcare does not reach many communities (i.e., it is falling short of 100% scale); and often the healthcare that does reach communities is not available in a consistent ongoing manner which is affordable to the patients, with governments and/or donors paying for that healthcare (i.e., it is falling short of 100% sustainability). The lowest level of the health system, often called the “last mile” where healthcare is provided, is generally the most difficult and weakest link in healthcare delivery. At this level, the health system and the resources available to it must be spread very thin across vast geographic areas. To deliver quality healthcare to the last mile, it must overcome significant challenges, including: human and financial resource constraints;lack of information regarding health system operations which is needed to manage for improved performance; andlack of infrastructure needed to support healthcare delivery (e.g., energy, transport, information communications technology). These challenges are exacerbated by the lack of effective and efficient healthcare delivery support services deployed by health systems in low- income countries. Donor support remains a large contributor to health sector financing, but it is easier to fund tangibles, such as people, medicines, etc., than ongoing operational expenses or systems change. For example, Gavi and other large donors have solved financing for vaccines, but investments in the systems to support distribution of those vaccines have received less focus. Overall, there is a lack of incentives tied to health sector performance. For the individuals and communities served by the health system, the current equilibrium means delays in receiving appropriate care, inability to access critical services, and a lack of clear information about when, how, and where to seek healthcare services. This contributes to the community’s lack of trust in the health system and often, a lack of incentive to seek care. This system perpetuates a reality in which resources, technologies, products, and benefits to do not reach the end user, who is disempowered geographically and politically.

New Equilibrium

Proven system innovations targeted at the lower levels of health systems can establish a new equilibrium with dramatically improved and sustainable access to quality healthcare at scale, especially for the most under-served communities. An efficient system would perform at its maximum contribution towards access to quality healthcare and deliver healthcare products and services reliably. This will be achieved when both donors and government actors are aligned in creating the right environment for absorbing and scaling system change. This requires a shared appetite for change and a common understanding that improving access to quality healthcare requires more than implementing new approaches and technologies. Sustainable innovation also depends on the ability of the health system to absorb innovation effectively and efficiently. By implementing new approaches for increasing access to quality healthcare at the last mile, VillageReach and its government partners build the robust evidence and data needed to assess and prove the impact of system changes. This evidence helps to create positive incentives for governments and donors to challenge the status quo and to create an enabling environment for change. Collaboration and transparency between actors is paramount to this new equilibrium as both donor and government agendas are critical to driving the political will for systems change. At the community level, when there is better access to quality healthcare, individuals trust in the health system, engage with it, and have more control over their healthcare decisions. Through collaboration with public and private sector partners, VillageReach seeks to increase access to quality healthcare for the world’s most under-served communities, bringing life-saving innovations to scale and sustainability.

Innovation

(See corresponding graphs in attachment: Mission, Goals, Strategies) VillageReach’s methodology for successful system innovation contains four components: Learn, Develop,Scale and Sustain. The Learn and Develop steps occur first, at a smaller scale usually in ademonstration project with local partners. Here, VillageReach is able to exert direct influence over thedesign, implementation and impact of each system innovation. The Scale and Sustain steps involveVillageReach encouraging others (e.g., governments, global health partners and the private sector) toadopt and implement a proven system innovation across broad geographic areas and even across multiplecountries. In this area of activities, VillageReach has the opportunity to produce sustainable improvementsin access to quality healthcare at scale through the actions of others. Although all four steps require highlevels of VillageReach collaboration with government, non-government and private sector partners, theneed for VillageReach to collaborate closely with multiple partners is especially high in the Promote andSupport steps where VillageReach has only indirect influence over how, and the extent to which, thesystem innovations are deployed by others. To improve healthcare delivery support services at the last mile, VillageReach has builtexpertise across the following: Supply Chain Logistics. We implement data-driven approaches for comprehensive supply chain improvement. VillageReach works with ministries of health to assess current supply chain performance and identify strategies for improvement that lead to efficient, effective delivery of life-saving health products to the last mile. Health Workforce Development: We design practical approaches to address human resource gaps and strengthen health worker skills. VillageReach brings its last mile perspective to workforce development by assessing existing human resource strengths and gaps and designing strategies to improve health system efficiencies and positively impact patient care. Digital Health Technology: We develop technologies that improve communications and access to health data. VillageReach works with Ministries of Health to assess system requirements and develop strategies and solutions to optimize data collection and utilization, improve communications, and facilitate information exchange. Data Analytics: We help governments and partners make sense of complex health data to drive decision- making and continuous improvement. VillageReach deploys visualization and analytics to turn raw data into actionable intelligence that can drive decisions in low-resource settings. Key Innovations Include: Accelerating Next-Generation Immunization Supply Chains (iSC): VillageReach works with Ministries of Health to design and implement “next-generation” immunization supply chains to reach all children currently without access to vaccines. Along with our direct work with governments and their partners to implement new supply chain designs in Mozambique, DRC, and , we also drive change globally through advocacy, evidence- generation, and partnerships. In Mozambique, the new supply chain design has increased vaccine availability to 95 percent, enhanced performance of the cold chain and reduced the cost of delivering vaccines to children. Pharmacy Assistant Training Program Together with the Malawi Ministry of Health and the Malawi College of Health Sciences, VillageReach led the initiative to train and deploy a new cadre of health worker to improve data management, decrease logistics burden on clinical staff and improve quality of care. Pharmacy Assistants now work in health centers serving more than 1.5 million across the country.Chipatala cha pa Foni (CCPF), or Health Center by PhoneVillageReach developed and implemented Chipatala Cha Pa Foni (CCPF), a toll-free health hotline in Malawi. Trained health workers provide information, advice and referrals over the phone. Through partnership with mobile carrier Airtel, the Malawi Ministry of Health and other partners, CCPF continues to expand in scope and scale, bridging a critical gap in healthcare access, especially for remote communities.OpenLMIS VillageReach is a leading developer and implementing partner of OpenLMIS, an open source logistics management information system designed to manage health commodities in low-resource environments. OpenLMIS increases data visibility for logistics, ensuring efficient delivery of vaccines and other essential medicines. Today it is deployed in , Cote d’Ivoire, Mozambique, Tanzania/Zanzibar, and Zambia VillageReach's approach is differentiated from others in the space by the following factors: An approach to scale and growth that is oriented from the outset on other ecosystem actors adopting and sustaining the innovations. VillageReach proves the concepts and sustains the innovations long enough to build political will and funding mechanisms for others to ownCultivating and applying a combination of expertise - technology, health, private sectorFocus on the last mile - all innovations are designed to maximize impact at the last mile and in a holistic way to influence the required people, processes, ecosystem

Ambition for Change

Transform health care delivery systems to reach everyone, everywhere, so each person has the health care needed to thrive.

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