Getting settled in Mozambique

Rural health center flanked by VillageReach vaccine delivery vehicles

Greetings from Mozambique.  After several weeks in Maputo, I have settled into my apt, figured out the best place to buy the famous Mozambique prawns, participated in several eye-opening field visits with my co-workers at VillageReach, and begun to wrap my head around the Mozambique health care system. 

Prawns at the fish market

This is my first time in Africa and everyday offers a new adventure, however, one of my first great surprises was rooted not in the unknown, but in the European financial crisis!  Finding an affordable apartment in Mozambique was no easy task, apparently thanks to a recent influx of foreigners snapping up lodgings and driving up prices.  Mozambique is a former Portuguese colony and the contracting economy of Portugal seems to have spurred a torrent of Portuguese entrepreneurs looking for new opportunities in Mozambique.  Of all the challenges I had prepared myself for, unemployment in Portugal was certainly not one of them!  Luckily, eventually VillageReach found me a room to rent in the apartment of a young Mozambique professional.  Despite the occasional lack of water and 15 minutes it takes to get through all the padlocks, it is a beautiful apt perfectly located for me to get to work and around the city…not to mention that  I have a private balcony with a view of the city.  

Vaccine transport

This summer I will be implementing a comprehensive study documenting the range of obstacles challenging the reliable delivery of vaccines, rapid diagnostic tests, and medicines to rural communities of Mozambique.  While VillageReach is already actively working to address many of the known challenges in this area (such as lack of transport for vaccine and medicine delivery), the purpose of this study is to quantify the range of logistics challenges and flush out the sources of the problems.  For example, is transport a problem because of lack of vehicles, lack of fuel, broken vehicles, or the bureaucracy of gaining access to a shared vehicle when it is needed?  Where in the supply chain are problems most frequent: eg.,picking up the healthcare supplies from the central storehouses, or delivering them to the rural health centers?  Are health center employees adequately trained in the logistic concepts necessary for effectively keeping track of supplies and forecasting the health center’s needs? 

Data collection at a district health center 

These questions and many more will be answered using a lengthy survey that will be given in every district within the four Mozambique provinces (Maputo, Gaza, Niassa, Cabo Delgado) where VillageReach currently operates.  Last week we began training the VillageReach Field Officers in implementing the survey.  We will had an all day training session in our offices in Maputo followed by 3 days of visits to nearby district health centers to see what surprises we found in translating ideas on paper to workable information gathering in the field.  In the coming weeks, the Field Officers will continue to gather the data (I will join when possible) and send it all my way for synthesis and analysis.  The hope is that this study will provide more detailed information about the current challenges and thus help VillageReach and the Mozambique government prioritize their efforts to increase access to healthcare supplies to rural communities.  

View from a rural health center 

By far my favorite problem we encountered in the training came from trying to explain the concept of a “typical month”.  There are several questions in the survey that ask questions along the lines of  “In a typical month what sort of vehicles did you use to distribute vaccines?”  The concept of a “typical month” spurred a very spirited half hour discussion.  I was told that there was no such thing as a typical month and the question would confuse people.  The Portuguese translation was fine, the difficulty lay in the fact that everything changes so frequently and without notice in rural Mozambique, that the concept of things happening on a regular schedule in a manner that could be expected was just very difficult to digest.  I think there are few moments that sum up the challenges of working on logistics in rural Mozambique much better than this!