National Expansion of the Dedicated Logistics System

VillageReach has worked in Mozambique since the organization was established in 2001. In its initial assessment of the condition of the health system, VillageReach concluded that weak logistics practices, a lack of actionable information, and poor health system supervision were major impediments to the effective delivery of immunization services. Starting in 2002, a five-year demonstration project was conducted to ensure prompt and universal access to vaccines in the northern Mozambique province of Cabo Delgado. The ad-hoc, collection-based approach, where frontline health workers had to collect vaccines and related supplies from their district office and perform various logistics tasks, was replaced by a dedicated, integrated, distribution system where a small number of specialized workers visited each health center once a month to delivery vaccines and supplies, repair equipment, facilitate an information system and provide supportive supervision.

This reassignment of tasks to create a systematic distribution process, the related information management system, and an active and ongoing recurrent training and supervision program are the core innovations of the VillageReach Dedicated Logistics System. The model significantly improved operational efficiency at the service delivery level resulting in a dramatically higher immunization coverage rates for children in the region.

Since 2010, VillageReach has been providing technical assistance to the Mozambique Ministry of Health to scale the Dedicated Logistics System nationally. In addition to the distribution of vaccines, VillageReach is working with partners such as Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to integrate commodities such as Rapid Diagnostic Tests for HIV/AIDS, malaria, and syphilis into the system. The Dedicated Logistics System has been deployed in Cabo Delgado, Niassa, and Nampula Provinces supporting more than 400 health centers and is expanding to Maputo and Gaza Provinces in 2011.

VillageReach released the results of an independent impact evaluation of the pilot project and conducted a complementary study comparing the costs of the VillageReach designed logistics system with the system used in a control province. Following is a summary of those evaluations:

• DPT-HepB3 vaccine coverage rates increased from 68.9% to 95.4% for children age 24-35 months.
• All other vaccines had similar increases resulting in an average coverage rate of 92.8%.
• The reported monthly incidence of stock outs in rural health centers decreased from 80% to 1%.
• Up-time of the cold chain increased from approximately 40% before the project to 96% over a year after the conclusion of the project.
• An average of 95% of health centers were visited each month by the dedicated logistics system staff with an average interval of 31 days in between visits, despite extremely difficult road conditions and harsh rainy seasons.
• The VillageReach model was 17% more cost-effective, at $5.03 per child fully vaccinated with DPT-HepB3 compared to $6.07 per child vaccinated in Niassa where VillageReach was not engaged. The VillageReach system was also 21% less expensive per vaccine dose delivered: $1.18 per dose delivered vs. $1.50 per dose delivered for the control province.

Read the full impact evaluation and cost studies here.

Read  a complete, up-to-date history of VillageReach’s work in Mozambique here.

For more information on this program, visit the VillageReachFocus Mozambique page here.