The art of last mile public health supply and demand
Project Last Mile was recently featured in two episodes of the Art of Supply Podcast (by Art of Procurement), which focuses on thought provoking content created to illuminate the complexity of global supply chains. Host, Kelly Barner, used Episode 124 to tell the story of how Project Last Mile came about, and then Episode 125 to interview Adrian Ristow, Executive Director of Project Last Mile, and David Canarutto, Private Sector Relationship Manager at The Global Fund to Fight AIDS, Tuberculosis and Malaria, about some of the lessons learned along the Project Last Mile journey.
Both episodes yielded great insights and are worth a listen. Here are some of the highlights:
Saying “yes” sparked more than a decade of successful partnership
Kelly first came across Project Last Mile through a TED Talk by Melinda Gates in 2010, What Nonprofits Can Learn from Coca-Cola. Just a year earlier, in 2009, representatives from The Global Fund and the Bill & Melinda Gates Foundation had approached the Coca-Cola Company to find out the answer to the question: “If you can find an ice-cold Coca-Cola product almost anywhere in Africa, why not life-saving medicines?”
Kelly notes that what stood out to her was that 2009 was during the financial crisis and the worst economic downturn the USA had seen since the Great Depression. “Coca-Cola could have said ‘no’, or they could have said ‘maybe later’, or they could have said, ‘look, it’s a great idea, but now is just not a good time’. But they didn’t,” she points out.
Instead, Coca-Cola chose to find a way to work alongside African government counterparts to share private sector best practices in supporting and strengthening public health systems.
Fast forward to 2024, and Project Last Mile has worked in 17 countries across Africa and reached 43 million people.
Success factors
Adrian and David shared some of the lessons from the partnership, including:
- The importance of increasing sensitivity from the public sector around partnering with the private sector in a creative way rather than simply asking private sector donors or corporates to fund certain activities.
- Ensuring sustainability by bringing everybody to the table. In the case of Project Last Mile, this includes donors and implementing partners.
- Strategic vision and commitment. Adrian admits that in the beginning, some people thought it would be simple – a case of putting Coca-Cola people and ministry of health people in a room and letting them brainstorm solutions. “But we found that the private and public sectors speak two different languages,” he says. “Having a partner like Project Last Mile, with dedicated people who were able to translate the Coca-Cola system into what it means for the local operational reality for a health system, was important.”
- An idea at the right time – the context was right for leaders across the different sectors, including Coca-Cola as the private sector partner and the donors, who were spending billions on healthcare programmes in Africa and seeing limited impact. “They were open to finding new solutions,” Adrian said. “They approached the private sector with an open mind, rather than being prescriptive about how they wanted to partner.”
- Identifying resources and creating capacity. Adrian noted that projects might be well-intentioned but less likely to succeed if volunteers are tasked with managing them on top of their existing work commitments. Part of the reason he believes Project Last Mile has succeeded is that each partner carved out dedicated people resources with the necessary specialist skills to bring the idea to fruition. He says one of the other important success factors was the clear mandate he was given to find a way to make the partnership a reality rather than to test whether it was feasible. “We had strong commitment from the most senior circles in the organization. I was fortunate to be dedicated to the project as a Coca-Cola resource because they recognized that this required that level of focus,” he explained. The Global Fund and the Bill and Melinda Gates Foundation also gave people room and resources to invest in the partnership, as did other partners, such as USAID and PEPFAR, when they came on board later.
- An effective elevator pitch. David noted that the pitch – why should life-saving medicines not be as readily available as soft drinks – is simple, easy to understand and convey, which makes the partnership an attractive proposition. “Everybody knows Coke, and the brand is very market-relevant for whichever reality we’re talking about,” he said.
- A willingness to go slowly for the sake of sustainability and not just score the quick superficial wins. David noted that the quick win could be to outsource to someone else. “But that doesn’t sort the situation.” Rather than Coca-Cola simply distributing healthcare products on its trucks, the partners looked to create capabilities within the national ministries of health, using IP developed in the private sector. Adrian added that key to this was that from the start, it wasn’t going to be a Coca-Cola project, but a cross-sector partnership. While decision-making happens quickly in the private sector, Project Last Mile needed to take into account that the national health systems context is different and complex, and decisions may take much longer. “We needed to be clear on the role of the public sector versus the private sector, and how important it is in a public private partnership that the private sector doesn’t take over accountability for aspects of serving a population that should always be in the domain of the public sector or the government,” he explained.
Getting started
Before jumping into action, the initial project team made several exploratory visits to Tanzania, which is where the first project started, as there was a specific supply chain challenge to be addressed in the country.
These visits entailed understanding the context and seeking first to understand, rather than assuming the private sector would have all the answers ready.
“We worked really hard in building that understanding, and then that helped to build trust, which then is what gets people together on the same page,” Adrian said.
Measuring success
David explained that Project Last Mile measures its success using a combination of what he called “hard numbers and soft facts”. The hard numbers relate to the impact of single projects and what has been achieved in addressing the challenge at hand against a baseline – which can take years to implement. He added that as the partnership has grown, its scope has expanded from solely focusing on route-to-market or supply chain challenges to incorporating demand creation and strategic marketing.
Adrian added that the partnership has focused on creating sustainable impact, which meant it needed the flexibility to make mistakes, learn from them, and refine the model along the way. “We engaged an academic partner early on with expertise in health systems (the Yale Global Health Leadership Institute) who helped guide us on a basic monitoring and evaluation (M&E) framework upfront.”
This ensured that every project had specific goals, and the partnership could be held accountable for those objectives.
Co-creation and bravery
“I think one of the things that Coca-Cola does very well, is they know their market; they know their customer,” said David. “We have learned from that. It’s been a learning journey. In the beginning, we thought it would simply be a case of infusing best practices into the public sector healthcare supply chains, but we quickly realized that it’s actually about building local trust, local engagement, and co-creating a solution with the ‘customer’ and making the project the star of the show, rather than what we wanted to project upon it. We’re very proud of the fact that today, our best endorsers are actually the ministries themselves – the directors of central medical stores, people who have worked with subject matter experts from the Project Last Mile network – who can really say this has made a big difference. I think having been humble enough to say, ‘We don’t know’, and finding a strategic partner who’s also brave enough to partner with you in areas where you don’t know exactly what the solution will be, has been critical.”
He pointed out that the Project Last Mile model is not about implementation – it’s about accompanying the ministry of health as a partner. It’s not about doing the work for them but about facilitating engagement between the partners and bringing everyone’s expertise into play.
Infinite applicability
David shared that, to him, one of the stand-out successes of Project Last Mile is having a trusted partner to turn to with a problem set. This has seen the partnership grow into new countries and workstreams, leveraging lessons from previous projects to build new solutions.
“We’ve also had a number of similar partnership mechanisms that were started thanks to this,” he added. “It’s a new way for the private sector to partner with global health institutions. We have a partnership now, in sample transport for labs, that is based on the same principles. We have another partnership on healthcare waste with several companies, which is based on the same on the same kind of principles. The partnership with Coca-Cola is held up as the flagship model of what good looks like in terms of public private partnerships. The partnership has infinite applicability. If you think of any major global health problem, there’s probably a private sector company out there that’s figured it out. They have some IP, and it’s a case of finding how to ‘unbox’ that in the public sector.”
The power of people
Adrian noted that his best experiences in Project Last Mile have related to people. “It’s the manager working at a medical stores department who now has a system that works and is proud of being able to serve patients better. It’s generally not because of poor intent that medicines aren’t reaching the last mile. It’s just not having access to the types of systems that are so freely available in the private sector. Seeing the satisfaction of those people in government who are actually accountable and responsible when they feel like they’re fulfilling their mandate and serving their fellow citizens better brings me some of the most fulfillment. The other thing is the wonderful team we have developed in Project Last Mile. We have people with similar value sets who come together so and a core network of 50-odd people who work directly on our projects. Then, in The Global Fund, we have David and a number of his colleagues who have played a key role, and people in USAID, PEPFAR and the Bill & Melinda Gates Foundation. I think what’s kept us going for so long is that we’re all aligned to common objectives and goals. And that’s what’s enabled us to replicate successes into other countries.”
He added that his dream is to see this type of partnership model take hold across other sectors, from telecommunications to IT, with private sector and public sector parties being willing to engage to solve major challenges together.
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