Improving Vaccine Delivery In Mozambique
Wednesday, January 13, 2016
WDI’s Healthcare Research Initiative recently successfully completed a project with the government of Mozambique’s Ministry of Health (MOH) and VillageReach to establish better ways to measure performance at all levels of the vaccine supply chain and create better accountability structures. WDI and VillageReach also started a discussion with the MOH about sustainability of the project and shifting management of it to the government.
Vaccines save millions of lives annually and are among the most cost-effective health interventions available. But immunization coverage worldwide has stalled at about 80 percent, leaving one in five children susceptible to permanent disabilities from vaccine-preventable diseases such as diarrhea and pneumonia.
Improving access to lifesaving vaccines begins with a well-functioning supply chain. In Mozambique, VillageReach introduced a streamlined logistics system called the Dedicated Logistics System, or DLS. The system assigns logistics tasks to field coordinators in each province – there are usually two to four per province, integrating supervision and data collection into a system design, and leveraging existing transport infrastructure. It has been successfully scaled in four provinces, but questions remained about its sustainability. A performance management system could create better accountability and increased scrutiny within the DLS, leading to better outcomes, VillageReach believes.
For this project, DLS data was collected, reviewed and analyzed for two years. For the second year of the project, monthly performance reports were collected from each health facility and reviewed, and monthly meetings were held using root cause analysis tools to identify and solve problems.
The project team of WDI – which included two WDI summer interns the past two years – VillageReach and MOH researchers established two interventions in two study provinces, Maputo and Gaza.
The first intervention was implementing performance management tools. This included field teams routinely documenting challenges and sharing them with provincial health officials and other senior management at monthly meetings where corrective measures were discussed.
The second intervention was the recognition of top performers. The province showing the most improvement was awarded $4,000 to be spent however the provincial health officials determined.
A significant result of the project was that it led to a culture of problem resolution where none had existed before. Also, providing a forum to plan the next month’s distribution cycle and discuss problems with top health officials will lead to performance improvements in the long term, as the performance management tools become more routinely utilized within the provincial vaccine supply chain organization.
The interventions improved planning for the next distribution cycle to reduce things such as stockouts, and increased the ability to address issues encountered at the province, district and health unit levels. Another result is that the financial incentive was shown to be less important than increased accountability.
Of the improvements, a medical chief in the Gaza Province said: “We discuss some solutions and register these in a document. For instance, when mobile brigades weren’t carried out due to fuel, coordinators requested district to reach out to NGOs, like WorldVision.”
A medical chief in Maputo Province said: “We have the meeting notes from VillageReach and the reports help evaluate change between past and present; field coordinators are obliged to do a report after distribution.”
VillageReach will now work with the government to move it away from partner support and gain autonomy in addressing issues that impede distribution. This will include promoting distribution teams’ autonomy in solving challenges and increasing the government’s focus and awareness.