An “Insurmountable” Challenge: Reflections from Getting PPE to Health Workers in Malawi

By Hope Ngwira, Senior Manager, Advocacy & Communications

The Honorable Khumbize Kandodo Chiponda MP (second from right), Minister of Health, visits Chileka Health Center during a PPE donation ceremony.

[While this story is about PPE, logistics and delivery issues persist with the vaccine rollout. Read why the same lessons can be applied in June of 2021.]

Last year, Malawi received a much-needed shipment of PPE from China. PPE was an obscure acronym for many people prior to COVID-19. Today, these are products for which health workers are desperate. Miraculously, on March 25, 2020, Malawi received a shipment of PPE from the Chinese government. Surgical face masks, surgical gloves, infrared thermometers, medical goggles, boot covers and more were received to meet health workers’ most immediate needs in the country.

Global shortages, international transport challenges, customs clearance and other issues made getting PPE into Malawi a tremendous achievement. But getting PPE in country is only half the battle. A mask sitting in a warehouse is worse than having no mask at all.

As part of the USAID-funded Organized Network of Services for Everyone’s (ONSE) Health Activity, and under the Ministry of Health and Population’s (MoHP) guidance, VillageReach snapped into action. We had to overcome storage limitations, budget constraints and distribution hurdles — and swiftly. Thanks to 12 years working at the last mile in Malawi, these are the moments we were made for.

We used relationships with government leaders country-wide and knowledge of supply chains at last mile to plan and orchestrate a 10-day distribution in three days. Within hours we had a plan, within two days trucks were being loaded. My colleague and I traveled over 700 miles with about four hours of sleep over a 48-hour period. We would like to share three pieces of advice. The first and perhaps most critical, is for anyone thinking of donating equipment in low-resource settings like Malawi.

Pair your work on logistics with an in-country expert. While these PPE donations are more than welcome, we urge you to understand the downstream impact. Unlike products procured through usual channels, donations are typically accompanied by little to no consideration for how the donated supplies will make it to end users. The assumption is that getting supplies into a country translates to a fully executed delivery — that is, delivery to the exact place they are needed for use. That’s far from true, especially in resource-constrained settings, where infrastructure and resources to distribute products may not be available.

Be prepared to act quickly. Immediate delivery was essential, both because health workers needed the equipment urgently, and because storage space is finite. Keeping the donated products in central storage, where they would be protected from theft, would have limited the government’s ability to receive and store new shipments it was expecting. To deliver efficiently, we came up with a delivery schedule in a very short amount of time based on a distribution plan the government provided. We prioritized delivering to areas with cases first, and we drove through the night to make sure those places had their PPE first thing the next morning.

Allow for flexibility. All of this required mobilizing people to actually pack and deliver the PPE. This required us to be flexible with people, budgets and time. Our VillageReach staff had to change their scopes of work to provide sufficient manpower to move supplies in a short lead time. Flexibility — both within organizations and from funders — to re-purpose or quickly hire sufficient staff is an important part of the ability to rapidly respond to situations like this one.

Malawi’s COVID-19 Response Team, of which VillageReach is a member, is essential for facilitating responses. The response team supports critical measures by the MoHP to lessen the devastating impact of the pandemic in Malawi. It is through this platform that stakeholders jointly reflect on emerging challenges and identify how their competence and assets can be used to address the challenges.

As the head of Pharmaceuticals in the Health Technical Support Services Directorate, Godfrey Kadewere, said the week of the delivery, “We need to get word out to the secretary and minister that we have supplies flowing to health facilities, this is an exciting development in the face of what looks like an insurmountable challenge.”

In districts like Blantyre, and in most of Malawi’s public hospitals, health personnel were putting on a brave face considering the risks posed by the virus. Distributing this PPE to 25 districts plus central hospitals was an incredible feat. But we’re not done yet — additional efforts are underway by Last Mile Health and others to make sure that we can quantify and procure PPE for the country’s CHWs as well. PPE can mean life or death to a health worker. Our job is making sure that this essential equipment brings life.