How Project Last Mile adapts route-to-market strategies for public health

As a leading public-private partnership for health, Project Last Mile focuses on translating supply chain and marketing innovations and best practices derived from the Coca-Cola ecosystem and other private sector experience to strengthen public health systems down to the last mile. While inspired by proven methods from various industries, including the Coca-Cola system, Project Last Mile has developed its own proprietary intellectual property tailored to address public health challenges.

One of Project Last Mile’s core capabilities is route-to-market or RTM. In the private sector, RTM is a strategy businesses use to determine the most effective channels to deliver their products or services to their target markets.  The graphic below shows how a product moves from manufacturing to the point of purchase, utilizing both direct and indirect delivery methods through managed distribution partners and wholesalers. This approach allows for flexibility and scalability, ensuring products reach even the most remote communities.

However, getting the product to the point of sale is only part of the process. Strategic marketing plays a crucial role in motivating consumers to buy the product by aligning the supply with the customer demand. The graphic also highlights the importance of demand creation through strategic marketing, ensuring the product is not only available but also wanted by consumers. But that process is for a different blog post!

Illustrative route-to-market process for beverage products

As Phil Roberts, RTM Lead for South Africa at Project Last Mile, explains, in the private sector, RTM is everything from the warehouse to the consumer. Applying these principles to health products through Project Last Mile, he says, “We start with the consumer and engineer our solutions backward. We look to see how we create availability and accessibility at the point of consumption. Then we work backward to develop channels that meet the demand of getting the product to the consumer.”

South Africa has one of the world’s highest HIV-positive populations, with an estimated 7.8 million people living with HIV. The high numbers of people requiring routine access to medicines for HIV and other chronic conditions lead to congested health facilities, overburdened health staff, and challenges in delivering quality care. 

Understanding that many patients visiting public health facilities are collecting routine supplies of chronic medication, Phil gives the example of the Central Chronic Medicines Dispensing and Distribution initiative in South Africa, also known as dablapmeds. This program is a type of differentiated service delivery model that aims to improve access to chronic medications by tailoring services to meet the needs of patients. Differentiated service delivery programs like dablapmeds focus on providing patient-centered care, offering more flexible and convenient options for medication pick up, such as private pharmacies and automated collection points, to help decongest public health facilities and ensure consistent access to treatment. Since 2016, through the support of PEPFAR and USAID, Project Last Mile has partnered with the National Department of Health to support its dablapmeds initiative with technical assistance, governance, planning, and implementation oversight to support the successful rollout and expansion of the dablapmeds initiative. 

Route-to-market in practice: dablapmeds in South Africa 

In the private sector RTM model for a beverage and the public sector differentiated service delivery model like dablapmeds, the process starts with a central hub—whether a warehouse for beverages or a government central medical store or provincial pharmacy in the healthcare space. From there, a prescription arrives from a healthcare facility, just like an order from a retail outlet in the private sector. This prescription is sent to a third party, akin to a distributor in Coca-Cola’s system, who dispenses and packages the medicine at a central location.

For patients on the dablapmeds program, the process begins when they visit a health facility for a routine check-up and chronic medication collection. If eligible, they can join dablapmeds and select a convenient pick-up point for future collections. After their first prescription is dispensed at the facility, subsequent refills are sent to a nominated pick-up point, where the patient collects their medication without returning to the health facility until their prescription expires every six months.

This model closely mirrors Coca-Cola’s commercial RTM processes, allowing for efficient collaboration between the private and public sectors. By applying these private sector learnings, Project Last Mile helps drive efficiencies, expand reach, and strengthen healthcare systems in collaboration with public health providers.

Phil highlights that dablapmeds’ success is mainly due to the National Department of Health’s commitment to the program. The Department’s buy-in and funding have been crucial in enabling the private sector to provide essential services to public healthcare patients. This centrally coordinated program across eight provinces, which places the patient’s needs at the center, would likely have remained a pilot project without this support. “Since the program’s start, we have seen significant growth in patient participation and the number of medication pickup points,” he explains. “Patients collecting from external pick-up points have increased by 17% from 2023 to 2024, with 63% of all patients on dablapmeds now choosing these more convenient options. Additionally, 40% of all patients receiving antiretroviral therapies are now enrolled on the dablapmeds program for their medication pickups.” 

This growth reflects a shift towards more accessible and destigmatized healthcare, allowing patients to collect their medication from 2,910 external pickup points. “With over 3 million active patients and 10 million patient parcels delivered annually, the program continues to show strong uptake and preference among patients who appreciate the convenience of being able to pick up their medicines close to home and avoid long queues,” Phil adds. These achievements underscore the impact of the DSD model in making chronic medication more accessible while also reducing the stigma associated with frequent visits to public health facilities.

Project Last Mile continues to offer ongoing technical assistance to the National Department of Health and partners for dablapmeds. Read more about how Project Last Mile supported the National Department of Health with the expansion of dablapmeds to reduce disruptions to chronic medication access by providing rapid business continuity planning support through COVID-19, civil unrest, and natural disasters. This is just one example of how Project Last Mile applies commercial route-to-market approaches to strengthening health product delivery. 

Find more Project Last Mile RTM resources and case studies here.