Wed, Nov 20, 2024

Study SBA

Advertisment Image
Research

Leveraging Disruptive Technologies to Enhance “Last Mile” Cold Logistics Delivery Systems for Public Health Care Management in  Ntcheu District, Malawi

Armand Poblete

The problem statement:

Our proposed area of operations is the Ntcheu District in Malawi, a remote region in need of improved healthcare logistics and access to rapid temperature-sensitive medical supplies. Ntcheu District, located in the Central Region of Malawi, is home to a significant population that faces challenges in accessing quality healthcare services due to its remoteness and lack of basic infrastructure.

In this district, there is a pressing need for addressing the timely storage and delivery of temperature sensitive and rapid delivery of life saving medical supplies.  Unfortunately,  the district’s inadequate infrastructure, limited expertise, and transportation challenges hinder the effective delivery of crucial medical supplies (World Health Organization [WHO], 2015) to remote medical facilities. This is issue is exacerbated by the lack reliable electrical supply, refrigeration equipment, and cold storage facilities, poses significant obstacles to maintaining the cold chain (WHO, 2015). 

Link to Google Maps: https://goo.gl/maps/iFAPUXpBLwmXH7U97 

This problem statement’s goal is to highlight the key issues in the lack of minimal cold chain logistics applications and models in developing countries supporting and extending health care services in hard to reach areas and to emphasize the need for the development of comprehensive applied and modeled solutions:

  1. Inadequate In-Country Infrastructure: Many communities within this district often lack the basic necessary infrastructure, such as reliable electricity supply, refrigeration equipment, cold storage facilities, and transportation networks, to support the cold chain logistics effectively (World Health Organization [WHO], 2015). Unfortunately without the proper infrastructure, maintaining conditions for cold chain products becomes a challenge, leading to compromised efficacy and quality of medical supplies (Kumar et al., 2020) and the lack of accountability.
  2. Capacity and Training Gaps: The district experiences a shortage of trained personnel with expertise in cold chain management. Insufficient knowledge and skills in handling temperature-sensitive medical supplies, as well as limited awareness of proper storage and transportation practices, contribute to improper handling and compromised quality of the supplies (Henschke et al., 2019). This shortage of trained personnel with expertise in cold chain management, resulting in a lack of knowledge and skills to handle temperature-sensitive products appropriately (Mazzei et al., 2017). Insufficient training programs and weak regulatory frameworks contribute to inadequate capacity in managing cold chain logistics, increasing the risk of temperature excursions and product spoilage (WHO, 2015).
  3. Inefficient Transportation Systems: Inadequate transportation systems, including poor road conditions, limited access to remote areas, and insufficient transportation options, pose significant challenges for the timely and reliable delivery of cold chain products (Haidari et al., 2018). The district suffers from a lack of well-developed transportation networks, particularly in remote and hard-to-reach areas. Poor road conditions, limited access to transportation services, and inadequate availability of cold chain transportation vehicles contribute to delays, temperature excursions, and compromised quality of medical supplies during the last mile delivery (Makwiza et al., 2018). As a result, temperature-sensitive products often experience deviations from the required temperature range, compromising their efficacy and safety upon arrival at healthcare facilities (UNICEF, 2017) (WHO, 2015).
  4. Temperature Monitoring, Control and Data Management: Monitoring and ensuring the appropriate temperature range throughout the cold chain process is crucial for preserving the quality and efficacy of medical supplies (WHO, 2015). Monitoring and ensuring the appropriate temperature range throughout the transportation process is essential for maintaining the efficacy and safety of temperature-sensitive medical supplies. However, the Ntcheu District faces challenges in implementing robust temperature monitoring systems and controls. Insufficient availability of temperature monitoring devices, such as data loggers, and a lack of proper training in temperature management protocols lead to inadequate monitoring and increased risks of temperature deviations (Magetsi et al., 2019).
  1. Lack of Accountability and Quality Assurance: The Ntcheu District struggles with maintaining accountability and ensuring quality assurance in the last mile delivery of medical cold logistics. Weak regulatory oversight, inadequate documentation systems, and limited capacity for data collection and reporting hinder effective monitoring, tracking, and evaluation of the cold chain processes (Magetsi et al., 2019). Limited regulatory oversight, weak enforcement mechanisms, and inadequate documentation systems contribute to the mishandling and mismanagement of cold chain products, leading to compromised efficacy, wastage, and potential health risks (Pathak et al., 2018). Moreover, limited capacity for data collection, analysis, and reporting hampers decision-making processes, hindering the implementation of corrective measures and improvement strategies (WHO, 2017) (MoH, 2019).

The consequences of these challenges can be severe, as temperature excursions and compromised quality of medical supplies can lead to reduced efficacy, treatment/preventative campaign failures, and increased risks to patient/public health. Furthermore, the inadequate last mile delivery of medical cold logistics hampers the district’s ability to provide timely and quality healthcare services, exacerbating health inequalities and hindering progress towards achieving Sustainable Development Goal 3 (UNDP, 2015) (WHO, 2017).

Addressing these challenges in the last mile delivery of medical cold logistics in the proposed area of operations in Ntcheu District, Malawi is crucial for improving healthcare access and quality in affected communities and can serve as a model that can be implemented in different remote communities. Comprehensive solutions are needed, including the development of robust cold chain infrastructure, improvement of transportation networks, implementation of effective temperature monitoring systems, provision of training and capacity building programs, and strengthening of accountability and quality assurance mechanisms (Magetsi et al., 2019) (Henschke et al., 2019). Innovative solutions that account for the unique challenges of these contexts, such as the development of robust cold chain infrastructure, reliable transportation systems, enhanced monitoring and surveillance mechanisms, and capacity building programs, are urgently needed to ensure the safe and effective delivery of temperature-sensitive healthcare supplies (GAVI, 2020) (UNICEF, 2017).

A Multi-Disciplinary Approach Solution:

The strategic application/deployment of disruptive technologies can play a significant role in addressing the challenges faced in cold logistics in rural areas. Here’s how disruptive technologies can create a sustainable solution to the problems addressed:

  1. Inadequate In-Country Infrastructure:
    1. Renewable Energy Solutions: Implementing renewable energy sources, such as solar or wind power, can provide reliable electricity supply for refrigeration equipment and cold storage facilities in areas with inadequate infrastructure.
    2. Portable Cold Storage and IoT: Deploying portable and IoT-enabled cold storage solutions can overcome the lack of permanent infrastructure by allowing for temperature-controlled storage in remote areas.
  2. Capacity and Training Gaps:
    1. Online Training and E-Learning: Utilizing e-learning platforms and online training programs can provide accessible and cost-effective training for cold chain management, reaching personnel in remote areas and bridging the training gaps.
    2. Virtual Reality (VR) and Augmented Reality (AR): Implementing VR and AR technologies can offer immersive and interactive training experiences, simulating real-world scenarios and improving knowledge and skills in handling temperature-sensitive products.
    3. Partnering with Andrews University and Malawi Adventist University on an onsite training program in both the technology and safe handling specialized medical supplies and clinical specimens.
  3. Inefficient Transportation Systems:
    1. Drone Delivery: Utilizing drones for the transportation of cold chain products can bypass the challenges of poor road conditions and limited access, ensuring timely and reliable delivery to remote areas.
    2. Mobile Apps and Digital Platforms: Developing mobile applications and digital platforms for logistics coordination and optimization can help overcome transportation inefficiencies by connecting suppliers, transporters, and healthcare facilities, streamlining logistics operations.
  4. Temperature Monitoring, Control, and Data Management:
    1. IoT and Sensor Technologies: Implementing IoT devices and sensor technologies can enable real-time temperature monitoring throughout the cold chain, ensuring compliance with temperature requirements and facilitating proactive interventions in case of deviations.
    2. Blockchain and Distributed Ledger Technology: Leveraging blockchain technology can enhance data management, traceability, and accountability by securely recording and sharing temperature data and other relevant information across the cold chain.

  5. Lack of Accountability and Quality Assurance:
    1. Blockchain and Smart Contracts: Utilizing blockchain and smart contracts can enhance accountability and quality assurance by creating a transparent and tamper-proof record of cold chain processes, including product handling, storage, and transportation.
    2. Digital Documentation Systems: Implementing digital documentation systems and standardized data collection tools can improve regulatory oversight, data collection, and reporting, enabling better monitoring, tracking, and evaluation of cold chain processes.

By leveraging disruptive technologies such as IoT, blockchain, drones, and virtual reality, it is possible to overcome the challenges faced in cold logistics in rural areas. These technologies can help improve infrastructure, enhance training and capacity building, optimize transportation, enable real-time monitoring, and ensure accountability and quality assurance throughout the cold chain process.

The Total Addressable Market

References:

  • Health Policy Watch. (n.d.). One billion people lack access to health facilities with reliable electricity. Retrieved from https://healthpolicy-watch.news/one-billion-people-lack-access-to-health-facilities-with-reliable-electricity/
  • GAVI. (2020). Cold Chain Equipment Optimization Platform (CCEOP). Retrieved from https://www.gavi.org/programmes-impact/market-shaping/cold-chain-equipment-optimisation-platform
  • Haidari, L. A., Brown, S. T., Ferguson, M., Bancroft, E., Spiker, M., Wilcox, A., … & Lee, B. Y. (2018). The economic and operational value of using drones to transport vaccines. Vaccine, 36(29), 4288-4295.
  • Haji, A., Lowther, S., Ngan’ga, Z., Gura, Z., Tabu, C. W., Sande, J., … & Sharif, S. (2020). Implementing the World Health Organization Regional Office for Africa guideline on temperature monitoring, reporting, and management of vaccine distribution in Kenya: a systematic method to improve vaccine cold chain. BMC
  • Henschke, N., Sutcliffe, S., Nyamtema, A., & McMahon, S. A. (2019). Challenges to the provision of emergency obstetric care in Malawi: Perspectives of health care providers. BMC Health Services Research, 19(1), 1-11.
  • Magetsi, K. T., Chisale, S., & Mleme, T. (2019). Assessment of cold chain management practices in Malawi’s Expanded Programme on Immunization. Malawi Medical Journal, 31(4), 260-267.
  • Makwiza et al.,( 2018).Cross-Scale Properties and Socioecological Role of Indigenous Residual Moisture Cultivation Systems in Malawi. Retrieved from https://link.springer.com/chapter/10.1007/978-3-031-15097-5_9
  • Ministry of Health (MoH). (2019). National Health Logistics Management Information System Strategy (2019-2023). Retrieved from [Provide relevant source if available]
  • UNDP. (2015). Sustainable Development Goals. Retrieved from https://www.undp.org/content/undp/en/home/sustainable-development-goals.html
  • UNICEF. (2017). Immunization Supply Chain: Comprehensive Report. Retrieved from https://www.unicef.org/supply/reports/immunization-supply-chain-com
  • Anderson, J., & Healy, T. (2014). Growing cold chains in Sub-Saharan Africa. Global Health: Science and Practice, 2(2), 249-251. Retrieved from https://www.ghspjournal.org/content/1/2/249.short
  • Moner-Girona, M., Kakoulaki, G., Falchetta, G., Weiss, D. J., Taylor, N. (2021). Achieving universal electrification of rural healthcare facilities in sub-Saharan Africa with decentralized renewable energy technologies. Joule, 5(10), 2687-2714. doi: 10.1016/j.joule.2021.09.010. PMID: 34723134; PMCID: PMC8548985. Retrieved from https://www.sciencedirect.com/science/article/pii/S2542435121004384
  • Henschke, N., Berger, S., Pritsch, M., Neuhann, F., Biesalski, H. K., & Kraemer, K. (2019). Assessing the quality of health services in the Tanzanian Health System: Perceptions versus reality. International Journal for Equity in Health, 18(1), 348. doi: 10.1186/s12939-019-1115-z. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S1364032118307883
  • National Defense University Center for Technology and National Security Policy. (2017). Energy Access and Health Outcomes. Retrieved from https://www.csis.org/analysis/energy-access-and-health-outcomes
  • Williams, H. (2013, March 7). Energy poverty deprives a billion of adequate healthcare, says UN. The Guardian. Retrieved from https://www.theguardian.com/global-development/2013/mar/07/energy-poverty-deprives-billion-adequate-healthcare
  • Moner-Girona, M., Kakoulaki, G., Falchetta, G., Weiss, D. J., Taylor, N. (2021). Achieving universal electrification of rural healthcare facilities in sub-Saharan Africa with decentralized renewable energy technologies. Joule, 5(10), 2687-2714. doi: 10.1016/j.joule.2021.09.010. Retrieved from https://www.sciencedirect.com/science/article/pii/S2542435121004384
  • Cairncross, G., & Feilden, R. (2018). Smart electricity for refugee camps: Energy access and the case for distributed power. Journal of Energy Storage, 19, 26-31. doi: 10.1016/j.est.2018.05.003. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/ese3.314
  • Modi, V., McDade, S., Lallement, D., & Saghir, J. (Eds.). (2017). Energy access and development. The World Bank. Retrieved from https://books.google.com/books?hl=en&lr=&id=wXakDwAAQBAJ&oi=fnd&pg=PT9&dq=number+of+rural+clinics+without+electricity+in+developing+countries&ots=7WqPB5kDPm&sig=vvb1LNgYhj_KlsS7NeSNwZZ4jzs#v=onepage&q&f=false