In Mozambique, the World Health Organization estimates that only 40-50% of the population has regular access to public health services. Especially in rural areas, families suffer from poverty, food insecurity, and lack of access to basic services such as clean water or health facilities.
From 2002-2007, VillageReach administered a project in Mozambique that dramatically increased immunization coverage, improved health center reliability, and restored public confidence in the health system. In partnership with the Foundation for Community Development (FDC), a local non-profit organization, and the Mozambique Ministry of Health, VillageReach began a five-year program in March 2002 that redesigned the last mile logistics system to optimize performance. VillageReach implemented the program initially in the Mozambique province of Cabo Delgado and subsequently, at the request of the MoH, has expanded it to Nampula province. As of 2007, VillageReach’s local partner, FDC, assumed daily operational management of the program, ensuring local sustainability and local control. VillageReach is currently pursuing a national rollout of the logistics system.
The program served over 250 health centers covering a population of over 5 million and led to a 26.5% increase in the number of children fully vaccinated in Cabo Delgado province. An independent impact evaluation in July 2008 measured the impact, sustainability and replicability of VillageReach’s program in Cabo Delgado. Additionally, a cost-effectiveness study completed in June 2009 analyzed the costs of the VillageReach logistics system in comparison to the logistics systems used in other provinces of the country. The study found that implementation of VillageReach’s program resulted in both absolute cost savings as well as relative savings in cost per child vaccinated. .
Key Findings
Increased vaccination coverage
- In 2003, the DTP3 coverage rate in Cabo Delgado was 68.9%. In 2008, the rate had increased to 95.4%. All other vaccines had similar increases resulting in 92.8% coverage rate for all vaccines given to children.
Improved the quality of health services and access to vaccines
- The project dramatically reduced stock-outs. Less than 1% of health centers regularly reported a stock-out in 2006 compared to almost 80% in 2004.
- Field coordinators reliably visited over 90% of the health centers every month to deliver vaccines, gas and other supplies, provide supportive supervision to health center staff and to collect health center data for use in vaccine management, supply and logistics planning.
- The project directly improved the cold chain. 96% of the health centers visited had a working refrigerator over one year after the pilot project ended.
VillageReach’s vaccine logistics system is significantly more cost-effective than traditional vaccine distribution systems.
- Because of greatly higher vaccine coverage rates (95.4% in Cabo Delgado compared to 70% in Niassa, a comparison province), the dedicated vaccine logistics system in Cabo Delgado was 17% more cost-effective, at $5.03 per child vaccinated with DPT-Hep B3 compared to $6.07 per child vaccinated with DPT-Hep B3 in Niassa.
VillageReach’s vaccine logistics system is more cost-efficient than traditional vaccine distribution systems.
- The dedicated vaccine logistics system in Cabo Delgado was 21% less expensive per vaccine dose delivered when compared to the traditional system used in neighboring Niassa province. The Niassa system cost $1.50 per dose delivered versus only $1.18 per dose delivered in Cabo Delgado.
VillageReach’s vaccine logistics system allocates more expenses to the actual cost of vaccines rather than to the distribution system.
- In the vaccine logistics system in neighboring Niassa province, the purchase cost of vaccines and syringes comprised only 46% of total distribution system expenses, while in the VillageReach system, they totaled 61% of the vaccine logistics system expenses.
VillageReach’s vaccine logistics system increases health worker and health system productivity.
- Changing from a diffused to dedicated logistics system saves staff time and resources. Our costing study found that implementing the VillageReach logistics system in Niassa province would result in freeing up 216 days per month of Ministry of Health staff time.
Knowledge of, trust in, and use of health services increased.
- 91% of the families interviewed had visited the health center in the last month despite 47% of families living over two hours away and 85% of them having to walk to get there.
The positive impacts of the project are sustainable, if essential project components are maintained.
- Coverage rates for children vaccinated during and after the end of the project remained close to 90% or above.
The project is replicable.
- The project has already been replicated in Nampula, where it is currently operated under FDC management. Project staff and MISAU officials support the expansion of the project to other provinces and areas.
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Mozambique Stats |
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| Population | 21,669,278 |
| Rural Population | 63% |
| Population living below international poverty line of $1.25 per day | 75% |
| Life Expectancy | 50 |
| Hospital Beds per 1,000 people | 0.8 |
| Maternal Mortality – Lifetime risk of maternal death | 1 in 45 |
| Immunization Rates (DTP3 Vaccination Coverage of 1 year olds) | 72% |
