Project Last Mile has been working in Sierra Leone since 2018 when USAID invited us to support the Ministry of Health with technical assistance and capacity-building. This support provided for last mile delivery of lifesaving medicines and commodities in the wake of Ebola.

In the years since we have supported the Ministry of Health and Sanitation and the National Medical Supply Agency (NMSA) in redesigning the last mile supply chain to optimize distribution. We have also begun to focus on improving supply chain commodities available through the Free Health Care Initiative and investigating the implementation of a digitally-integrated last mile strategy.

Initially, in 2018 and 2019, our work focused on piloting a new last mile delivery model across 23 primary healthcare units in Makeni (Sierra Leone’s fifth largest city). Then, in 2020 and 2021, the pilot was expanded to two districts – Koinadugu and Falaba. The expanded pilot focused specifically on strengthening the supply of family-planning commodities, plus testing a simple digital tool for inventory tracking at facilities.

Expanding the last mile delivery model

In early 2021, USAID engaged us to begin a third phase of work in April 2022, this time to facilitate the expansion of the last mile delivery model. During 2022, Project Last Mile supported USAID and its implementing partner, Momentum Country Global Leadership (MCGL), to pilot a more sophisticated last-mile digital tool for inventory tracking and dispensing, as well as perform a rapid digital assessment to support the design of a national Electronic Logistics Management Information System (eLMIS) for the last mile tier of the health supply chain.

As part of this process, Project Last Mile has completed a rapid digitization assessment to evaluate the best potential mobile eLMIS solution to fit the requirements for improved supply chain data visibility at last mile health facilities in Sierra Leone.

In collaboration with MCGL, Project Last Mile kicked off a pilot to test the suitability of mSupply Mobile, the last-mile complement to the digital platform already active at Central and District levels. This is the app that Matthew Yamba has been working with. The pilot has spanned 25 facilities in three districts. One of the facilities that is part of the pilot is Lakka Community Health Centre, which is trialing the mSupply Mobile application as a potential digital solution.

New digital tool helped to improve inventory management and reporting down to the last mile.

The center is headed up by Matthew and his team of 37 staff (10 of whom are volunteers). It offers a broad range of community health services, and serves a catchment area of more than 22 000 people. However, Matthew says his and his team’s administrative work is now far more manageable, thanks to the new digital tool that has helped to improve inventory management and reporting down to the last mile.

Some of the health care workers at Lakka Community Health Centre.

“When we were using a paper system, it was difficult to manage,” he says. “There are many people dealing with these documents, and sometimes the document has been lost, so information is then hard to get. The app we use now is essential to the management of the facility.”

Matthew says the new digital system has improved accountability, reduced the risk of human error (or forgetfulness), and allows the staff to reliably track all medicine and treatments dispensed.

Digitization on its own is not necessarily enough.

One of the interesting lessons for Project Last Mile has been that digitization on its own is not necessarily enough – the pilot areas where digital tooling was combined with regular support and monitoring visits were significantly more successful and saw far less attrition than facilities receiving a digital tool without active support.

However, for many healthcare workers and volunteers who have been part of the mSupply mobile pilot, the digital tool is already improving their ability to serve patients.

“The mSupply introduction to our facility is good for our daily activities, especially patient information recording, recording-keeping and commodity management on a daily basis, as well as requesting information,” says one staff member.

Andrea Kanu, a healthcare worker at Laka Community Health Centre in Sierra Leone, says that previously, she had to wait for her boss to manually write out patient dispensing information in his record book before she could treat the patient. Now, the clinic is using connected tablets to do this, and she can quickly and easily capture the information herself and check stock levels to see which medication is available.

“The application is good and helpful,” says another. “It has improved my records in terms of drug stock levels, especially monitoring patient flows and improving the accuracy of data.”

Using the results of the rapid digitization assessment and lessons from the pilot, Project Last Mile will now work to develop a robust, scalable last mile delivery model that incorporates both the service-level requirements and a fully digitized logistics management information system to improve the data accuracy, timeliness, and integrity for effective decision-making, flow prediction and procurement of all public health commodities at last mile health facilities in Sierra Leone.

This initiative is funded and supported by USAID. The content and information provided on this website are the responsibility of Project Last Mile and are not official United States government information and do not necessarily represent the views or positions of USAID or the United States Government.