VillageReach Measures Its Success in SmilesPublished: June 18, 2003 in Knowledge@Wharton
During the devastating floods that swept through Africa back in 2000, Blaise Judja-Sato traveled to Mozambique to assist in the country’s relief efforts. He saw a land ravaged by years of civil war and environmental disaster whose infrastructure was alarmingly weak and whose health-care system was faltering. Yet Judja-Sato also saw a country filled with people whose strength and resilience helped them endure enormous hardships without losing hope that something better could be around the corner.
“I saw huge potential within the country," Judja-Sato recalls today. "Many people from the government, private sector and other communities were ready and willing to contribute towards improving the overall health and well-being of the population. I also realized that in most cases, they lacked the tools to achieve their goals – and that’s where I saw an opportunity to help.”
And help he did. Judja-Sato, who was born in Cameroon, founded VillageReach, a non-profit group based in Seattle, and assembled a team of experts with extensive experience in public health and development fields who were enthusiastic about attempting a fresh approach to tackling problems that plague so many developing countries. Judja-Sato figured that international commitments to improving lives in countries with the greatest need offered an opportunity to strengthen the role of immunization as a platform to provide other essential services for hard-to-reach populations.
In an attempt to solve that problem, VillageReach began to develop a scalable, sustainable model for improving access to immunization while addressing larger social and environmental problems that contribute to poor health. “It simply was not enough to make sure vaccines and related supplies were reaching the clinics on time and in adequate amounts," says Judja-Sato. "We needed to look for ways to achieve significant, measurable, sustained improvements in the lives of remote communities.”
Judja-Sato and VillageReach offer good examples of the kind of thinking that applies business concepts to solving social problems, which Knowledge@Wharton recently highlighted in its special report on social entrepreneurship. In VillageReach’s case, Judja-Sato, who graduated from Wharton in 1994 and is a former executive for Teledesic, a broadband satellite company, recognized that getting vaccines and other medication for immunization to remote villages is essentially an exercise in logistics similar to those that companies with complex supply chains confront every day. While it was difficult but possible to get vaccines to cities and urban centers in Africa, the real challenge was to get it to the most remote villages, which lack refrigeration and other storage facilities.
In addition, Judja-Sato’s efforts, if they succeed, could have implications that reach beyond Mozambique or even Africa. The United Nations Millennium Summit in September 2000 called for a dramatic reduction in poverty and marked improvements in the health of the poor. There is a growing appreciation of the need for new strategies for achieving these goals in most low-income countries. At such a time, a comprehensive model of the kind that VillageReach has developed -- and that allows governments, businesses, foundations, and NGOs to reduce child mortality and improve health, while addressing environmental and social problems -- could have a broad, even global, impact.
With the backing of a group of influential supporters, including Graca Machel, wife of Nelson Mandela, VillageReach set out to create a project model capable of addressing a number of key shortfalls within the public services sector. Cabo Delgado province in northern Mozambique was chosen as the proposed site for a pilot project to test the VillageReach model after identifying regions with the greatest need according to leading health and economic indicators. Cabo Delgado is a remote area, located 900 miles north of the capital city of Maputo, with a high proportion of families living in rural villages where access to routine health care and immunizations is severely limited. Poor roads, recurrent flooding, and lack of spare parts and fuel compound the difficulties that health workers face as they attempt to stem the persistent threat of infectious diseases like measles and TB, diseases which are rarely a cause of concern among citizens of industrialized nations.
With annual under-five child mortality rates as high as 208 per 1000 children (WHO’s figures) and vaccination rates in some areas as low as 29%, it was clear that rural Mozambicans needed a healthcare system that was robust enough to overcome the challenges of minimal funding, lack of infrastructure and severe understaffing. The solution? Increase efficiency, improve transport, upgrade equipment and implement best practices like routine maintenance and on-site training that maximize the impact of scarce government resources.
That is what VillageReach and its project partners set out to do. After completing a feasibility study in June 2001, they presented their plan to the Mozambique government and began a period of fundraising to support the first phase of their program. Many long hours of meetings with donors, planners and government officials ensued until finally, in March 2002, VillageReach signed a long-term agreement with the Mozambique Ministry of Health for the provision of services to improve and streamline the nation’s healthcare system.
Once the agreement was signed, VillageReach operations went into high gear. Everyone involved knew that every hour lost was an hour that could have been used to load another truck full of lifesaving vaccines, medicines and supplies bound for a rural clinic. Just four months later, in July 2002, VillageReach made its first delivery of vaccines and medicines to 22 initial health facilities. Since then, fully-loaded VillageReach trucks have become a regular sight along the dirt roads of Cabo Delgado. As of April 2003, supplies were being delivered to 36 health facilities in five districts serving more than 800,000 people.
Some signs of VillageReach’s impact are now becoming apparent. By March this year, voluntary immunizations in some areas of Cabo Delgado were up by as much as 40%. This was one of the anticipated results of making several visible improvements to the local health care system. According to Judja-Sato, "Once families can see that supplies are being delivered regularly and that clinics are equipped with new, reliable refrigerators for proper storage of temperature sensitive vaccines, there is an immediate increase in trust and a greater willingness to make the effort to utilize available services."
Another critical area that the model addresses is injection safety. Recent studies have found that more than 50% of all injections given in developing countries are done using syringes and needles that have not been sterilized. Unsafe injection practices in the less-developed countries account for an estimated US $35 million a year in health care costs and 1.3 million deaths a year as a result of at least 8 million new cases of hepatitis B infections, 2 million hepatitis C infections, and 75,000 new cases of HIV/AIDS. VillageReach is working with partners to implement safety standards including better sterilization and waste disposal practices. Their hope is that by training health workers in conjunction with the introduction of new tools and technologies, they can massively reduce the burden of disease resulting from unsafe health care practices.
A Matter of Energy
Judja-Sato claims that one of the most exciting components of the VillageReach model is the capacity to establish income-generating activities that address primary community needs while contributing to the model’s overall cost-effectiveness. In its Mozambique pilot project, VillageReach identified the need for an alternative fuel to power essential equipment (e.g. refrigerators, lamps, sterilizers) in rural health facilities. Outdated, inefficient kerosene-burning refrigerators and lamps -- which are often used in such regions -- require constant maintenance and hard-to-find spare parts. Additionally, the burning and storage of kerosene itself can create health hazards, making it an inappropriate choice for use in a health care setting. Because availability of alternative fuels in the region was scarce, VillageReach set out to find a way to provide health facilities with an affordable, clean-burning alternative to kerosene.
To achieve this goal, VillageReach and its on-the-ground partner, the Foundation for Community Development (FDC), established VidaGas. VidaGas is a Mozambique-based company whose primary mission is to supply the Mozambique Ministry of Health with propane gas, also known as LPG, for powering essential equipment in health facilities like lamps and refrigerators. In addition to serving the needs of rural clinics without access to electricity, propane is an efficient, safe alternative to biomass fuels (e.g. wood, charcoal, dung) and kerosene which have traditionally been used by households and local businesses for lighting, cooking, and a variety of other activities. Profits from VidaGas sales are expected to partially cover VillageReach’s project costs, helping to ensure long-term financial sustainability. The local economy also benefits through the creation of new jobs and the reliable availability of fuel that is essential to the success of local businesses such as hotels and restaurants.
According to Judja-Sato, "Partnership-building is central to all VillageReach activities." The organization has recently teamed up with the Ministry of Mineral Resources and Energy in Mozambique to encourage families and businesses to adopt LPG as a primary fuel source. Plans are also underway to establish micro-lending programs to facilitate the initial purchase of equipment such as cookers and lamps which average around $40 for a complete household package. Long-term economic benefits are expected from households and businesses being able to perform a wider range of activities with less effort spent on acquiring and utilizing the necessary fuel.
For example, with access to LPG-powered refrigerators and freezers, local fishermen would be able to preserve the day’s catch, eliminating the need to drastically reduce prices in order to avoid losses from unsold fish. For women and children, LPG cookers would mean an end to the daily routine of having to collect and carry firewood for that day’s meal, freeing up time for other activities such as education, farming and other small businesses. In addition, adults who cook dinner over a gas stove suffer fewer respiratory and other health problems (e.g. pregnancy-related complications, blindness, asthma, and heart disease).
International organizations have started paying close attention to VillageReach and its models. Judja-Sato says that several countries have expressed interest in adopting -- and adapting -- the model to serve their needs.
A partnership is also in the works at Wharton. Paul Kleindorfer, co-director of Wharton’s Risk Management and Decision Processes Center, who has done substantial research on the economics of energy, has begun working with VillageReach to help align its programs with the School’s newly founded Social Impact Management Initiative, focused on sustainable management practices, emerging economies and social entrepreneurship. Says Kleindorfer, “Together with micro-financing innovations, the VillageReach model could be a critical element in tackling the problems that plague remote regions of the developing world.”
Judja-Sato, meanwhile, is already planning his next steps. “We have a model that works," he says. "Now our job is to find the best way to expand our services and apply the model in other country settings while continuing to improve and refine our strategies. My dream is that we can continue to find new and better ways to help governments break cycles of poverty and disease. The success of VillageReach will ultimately be measured by the number of smiling faces in the communities we serve. They are our most valued outcome.”