Reaching the last mile: The future of medicine access for everyone

Edward Wilson

According to the World Health Organization, much of the world’s burden of disease can be prevented or cured with known, affordable technologies. The problem is getting drugs, vaccines, information and other forms of prevention, care or treatment — on time, reliably, in sufficient quantity and at reasonable cost — to those who need them.

Universal health coverage requires universal access to medicines, vaccines and other health commodities. Over the last 30 years, and especially in the last decade, tremendous effort and funding has gone into improving the availability of contraceptives and other reproductive health commodities, of essential medicines to treat HIV, malaria and tuberculosis, and of new vaccines and new presentations of traditional vaccines.

Millions of lives have been saved or improved. But there’s still a long way to go, especially in reaching every person, every community at the last mile, in a way that saves lives, empowers communities, and builds resilient and equitable health systems.

Supply chains play a central role in achieving the goal of universal health coverage, and we have seen that the best practices applied in the past to get systems organized — assessments, system designs, standard operating procedures, capacity building, product integration — must evolve to include new tools, technologies and approaches.

Here are seven ways to improve supply chains:

1. Adapting commercial supply chain best practices to the mission-driven supply chains for public health for improved efficiency and effectiveness. This includes economic evaluation for identifying cost-effective interventions and analyzing the cost-benefit of different design options as well as supply chain modeling techniques to guide system optimization decisions.

2. Creating more integrated supply chains using a combination of comprehensive strategies, information technology for better end-to-end visibility, optimized design, empowered management, effective collaboration and continuous improvement.

3. Empowering supply chain stewards who apply a systems perspective and a total market approach that embraces the multiplicity of supply chain actors, leverages the private sector and emerging insurance schemes and emphasizes cost-effectiveness.

4. Identifying and integrating new delivery mechanisms, such as unmanned aerial vehicles or UAVs to serve remote areas or to provide direct delivery to the customer.

5. Empowering communities and local governments with user-friendly information systems and decision support approaches that enable them to take control of their supply chains at the last mile.

6. Aligning incentives throughout the system and especially at the last mile to help people perform at their best.

7. Applying predictive analytics and business intelligence to more closely predict demand and match standing inventories to short-term requirements.

The application of these new tools and approaches is more critical than ever. Every supply chain has a literal last mile, the crucial final leg to reach the customer. But in public health there’s also the figurative “last mile” that means reaching the hardest to reach segments of the population. Most of the people who lack access to medicines and vaccines today are either the most remote, living far from paved roads and affordable transport, or the most economically impoverished, preventing them from paying out-of-pocket for services and commodities.

Building supply chains for universal coverage — covering the last mile to each of them — requires innovation, creativity, commitment and a willingness to bear the costs.

It all sounds very technical and supply chain geeky, so it’s critical that we never lose sight of our goal; getting products to people. We must constantly ask: Where do they live? Where do they shop? Where do they get their services? How much income do they have? What are their barriers? Supply chains must be agile enough, smart enough, and resourced enough to respond to these needs.

Edward Wilson is director of John Snow, Inc.’s Center for Health Logistics, where he oversees a portfolio of over 30 projects across Africa, Asia, and Latin America. Wilson has over 30 years of experience working in low- and middle-income countries in Africa, Asia, and the Caribbean providing both short- and long-term technical assistance in project management, capacity building, public health supply chain management, management information system design, and software.


access to medicines, universal health coverage, health systems, supply chains, supply chain management, public health, delivery mechanisms, technology, health equity