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Challenge                                                                            Childhood vaccination, a necessary and thankfully common event in the industrialized world, is often an unaffordable and unavailable luxury in the developing world, where a child is ten times more likely to die from a vaccine-preventable disease than their peers in industrialized countries. Often times, the problem is as basic as the inability to move life-saving vaccines from urban centers to the rural areas- home to roughly half of the population of Mozambique, and 70% of the population of the Cabo Delgado province. It is here, where infrastructure such as roads and reliable energy are never guaranteed, and the cost of delivering medical supplies can reach five times the cost of supplying urban clinics. This process of moving the appropriate amount of necessary vaccines and supplies relies on a series of steps, each entirely dependent on the one before it, forming a complex supply chain that can be derailed at any one of its links.

The success of any immunization program depends on the cold chain to keep vaccines at the proper temperature. It is essential to maintain an unbroken cold chain for vaccines from the point of manufacture until they are used.

Procurement                                                                               The purpose of the procurement process is to make sure that the clinics have the resources needed to meet the needs unique to the community they serve. This, in turn, requires identifying the sources of those goods and services and the way in which they will be acquired.

Transport                                                                           Transport is the means by which supplies reach the places where they are needed. A strategy must be developed to ensure the safe physical delivery of the supplies, including providing refrigeration for vaccines and the consideration of alternative plans in order to keep the supply chain uninterrupted in the event of difficult scenarios, such as washed-out roads or bridges.

Storage                                                                                      The purpose of storage is to protect the needed supplies in an organized, systematic fashion until they can be delivered to clinics and individuals. It must also take into account reserve supplies, or stockpiles, for future or unforeseen emergency needs.

Distribution                                                                                 The chief goal of the supply chain is delivering aid to people in need of medical care while considering existing needs in a way that is fair and controlled to prevent abuse or waste.

It is important to realize that each of the above steps are closely linked, and that the failure of any of the links will directly affect the ability to provide necessary care to a community in need. For example, if an appropriate amount of vaccines are acquired but the appropriate storage has not been provided, the work invested in the procurement has been lost, the vaccines are wasted, and the necessary care has not been provided. Alternatively, if the vaccines are procured and stored correctly, but the effort to transport them to rural areas fails, then the success up to that point will have ultimately resulted in failure. One missing link is all that is needed for the chain to break, and the communities to continue without their basic needs met.

Source: World Health Organization, PATH

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Solution                                                                                  VillageReach is setting new standards in supply chain logistics for the regular delivery of vaccines and other medical supplies to clinics in rural areas of Mozambique. Based on data collected from each clinic, VillageReach works with the Ministry of Health to procure appropriate amounts of medical supplies as to prevent shortages and overstock waste. The materials are then transported to the Ministry of Health regional warehouse, a location conveniently shared with VillageReach's provincial office, where necessary storage space and refrigeration can keep the materials secure and in good condition.

Under the previous system of distribution, clinic workers in need of vaccines and other medical supplies were required to travel many miles, often on foot, to a provincial or district warehouse to obtain supplies that were not always available. Today, in Cabo Delgado, health workers at 90 rural clinics receive monthly deliveries from one of VillageReach's three delivery trucks, specially outfitted to navigate the difficult terrain of rarely maintained roads and sustain the cold chain necessary for the safe transport of vaccines. As the VillageReach drivers leave from the provincial warehouse for two-week excursions, they bring with them the necessary vaccines, medical supplies, and energy needed by each clinic to serve their communities. In addition, the VillageReach staff bring their knowledge of refrigerator maintenance and spare parts needed to ensure continued cold storage at each clinic. In the event that an urgent need arises between deliveries, VillageReach has outfitted many communities with bicycles or motorcycles to ease the burden of traveling to the warehouse.

The VillageReach supply chain provides communities in Cabo Delgado safe syringes and medical kits for common illnesses and five different vaccines allowing for childhood immunization against tuberculosis, diphtheria, pertussis (whooping cough), tetanus, hepatitis B, polio and measles.

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