• Remember my post on how to get patients and health care together? It turns out that I had forgotten one major factor: legal bickering. At least, in Australia.
• Yet another idea to combat counterfeit medicine. Not a bad one as things go, but again missing the poorest. Not that I would know how to do better.
• The UNDP has put out an RFP for ‘the Provision of Services to Strengthen the National Supply Chains for HIV/AIDS, TB and Malaria Programmes in Northern Sudan’. Section 8 can lead to some interesting issues.
• This year’s Aid & International Development Forum seems to have a lot of logistics subjects, starting with the first session: “Transport – How to achieve effective transport with smaller NGOs”. Could be very interesting if you are anywhere near. If you do go there, please post some feedback here.
• Fast Company showcases eleven designs for when disaster strikes. Unsurprisingly, logistics figures prominently.
• The International Transport Journal writes about aid logistics. It paints an overly rosy picture, but overall it is not a bad introduction into international emergency aid logistics.

[Image: Liquid Links by Desirae; some rights reserved.]

Related posts:

1. Humourless links for May 8, 2010
2. Humourless links for April 28, 2010
3. Humourless links for March 1, 2010

• An old post by Jeff Ashcroft at the Supply Chain Network talks about applying supply chain management principles to human resource management. I guess it is the HR equivalent of my application of the five rights of logistics to information management. (H/T to Jurgen Hulst.)
• IRC’s Anna Husarska writes about the significance of the chukudu, the wooden ‘bike’ that you can see everywhere in Goma.

[Image: Liquid Links by Desirae; some rights reserved.]

Related posts:

1. Humourless links for January 3, 2010
2. Humourless Links for June 13, 2010
3. Humourless links for May 8, 2010

The day, water, sun, moon, night – I do not have to purchase these things with money.

- Plautus

Was Plautus ever wrong.

It seems that it has been quite a while since I have written about the logistics of daily life, so let’s have a look at the logistics of what must count as the most daily of our needs: water.

First a truism: water is heavy. Just try to haul around 90 litres of the stuff and you will totally agree with me. In fact, it is so heavy that carrying it can lead to severe health problems. E.g., a 2003 Lancet article describes how 30-40 percent of a rural Tibetan population suffered from chronic back pain (a severe condition in a predominantly non-mechanised agrarian society), before an intervention aimed at correct carrying techniques and the building of ‘back-happy tap-stands’ (no, I really didn’t make that up – see the picture to the right to get an idea what it looks like).

In the developed world, we use this really nifty invention for our water logistics: pipes, a technology that has served us well for more than 2000 years (although one shouldn’t underestimate the amount of lead poisoning it has caused over the years – there are theories that it even contributed to the downfall of the Roman empire, although they are unlikely to be correct). For the moment, though, it is unlikely that water infrastructure will come any time soon to the remote areas of least-developed countries: the average Tibetan or Ethiopian subsistence farmer will still need to haul their water from a backbreaking distance.

That is why the hippo roller is such a great idea: by transforming the container itself into a wide wheel-like contraption, 90 litres of water at a time can be dragged around with a lot less effort: those 90 kilograms of water suddenly seem to weigh a lot less, and of course it can be transported much more hygienically than in an open container. So is it all downhill work from here?

Of course not. Even the hippo roller has some drawbacks that need to be worked on. Probably the most important one is… well, you guessed it, it is logistics. To make this a winning proposition, hippo rollers really should be produced close to where they are used, instead of shipped halfway across the globe: one of the litmus tests for the appropriateness of technology is whether it is feasible to produce it locally. A second issue is penetration: up to now, around 30,000 of them have been distributed, which is (if you allow me a very lame pun) nothing but a drop of water in the ocean. Such small numbers mean that it we really don’t have enough experience yet to know whether it really is such a good idea as it seems to be. It also means that there is no hippo-roller-repair man in every village, which means that it is unclear what happens with damaged rollers; and as I haven’t been able to find any evaluations yet, I really don’t know how long the average roller holds up in real life, or how easy it is to repair when it does get damaged.

Still, it is a good example of how creative thinking about logistics can help us to come up with ideas that will help the majority world immensely – and of how important logistics is for the daily life of all of us.

[Images: tap stand from the article by Hoy, Toole, Morgan & Morgan; uphill Hippo rolling by Project H Design. Some or all rights reserved.]

No related posts.

As I have written before, health logistics as a discipline tends to ignore the impact of the logistics of daily life on health. Possibly the clearest example is how physical access to primary health care impacts on health.

What do you do when you are seriously sick? Well, most of us in the developed world would go to a doctor. But what if that doctor is a four-hour trip away? Even here in Australia, a developed country by any account, access to health care is much worse in remote and rural areas than in the cities, and the health outcomes are as can be expected. Similar results have been shown in studies in other developed countries.

Obviously, things are much worse in developing countries. That four-hour trip suddenly translates in four days (or more) on the road, or rather, on a muddy track, on your own feet or bumping along on the back of some animal instead of a smooth ride in a car or train. The health outcomes are horrifying. For instance, a recent study in Ethiopia suggested that urban elderly Ethiopian women had about a 1.6-1.8 times longer life expectancy than rural ones. Or this one: the rural areas around Kunming (China) suffer from 50% more premature deaths than the city itself.

Solutions obviously need to be found, and some are already being implemented. Foremost, we need to concentrate more of our preventative efforts on less accessible areas. Of course, that is easier said than done: the same issues confronting a patient searching medical treatment, are hindering outreach and health education efforts — and when it comes to e.g. water and sanitation efforts, the logistics issues are even worse.

Another way to deal with these issues is by decreasing the distance between patient and health care. There are basically two ways of doing so: by bringing access points to the patients, or by bringing patients to the access points.

The former can be done by more dispersed access points, or by mobile clinics. Both have some serious drawbacks. Peripheral health access points are either unable to cope with more serious complaints, or would have to be impossibly well-equipped in a setting that is resource poor — you cannot put a secondary hospital in every hamlet, definitely not in a resource-constrained setting like a developing country. Mobile clinics can be slightly better equipped and resourced, but are only occasionally available to any given population and hence cannot deal with e.g. many emergencies, simply because they are not there when the emergencies occur; moreover, they are a shocking waste of time for the health care professionals, who spend much of their working hours trekking from one place to the next instead of on patient care.

Bringing patients to the health care settings is something that is rarely done. In developed countries we do so using individual patient transport (e.g. ambulances or commercial patient transport), but that is not an option for developing countries. Another way would be to use communal patient transport. Imagine a bus (or animal-drawn cart, or a caravan of donkeys or camels…) making scheduled rounds along a number of reasonably short circuits, picking up patients and delivering them to the nearest health care facility, and returning them on the next round after treatment. It would still not solve the problems of emergency care, but for the less acute cases it would bring patients possibly faster and more comfortably, but definitely at less cost for them to the care they need — without wasting a valuable and scarce resource, health professionals’ time.

Obviously there are issues around it that need to be solved, but it seems to be a intriguing possibility with many possible advantages. I know it has been done at very small scales, e.g. in refugee camps and in the immediate surroundings of some health posts here and there, but as far as I know it has never been tried in a larger area (but I would be chuffed to be corrected). High time for a trial, I would say.

(Images by Aaron Wieler and Shawn Alladio.)

Related posts:

1. The public/private mix in health logistics
2. Three parties rolled in to one: third-party logistics for global health and aid
3. The unanswered questions of aid and health logistics

Talking about health logistics, we tend to concentrate on heath systems logistics, i.e. the logistics of the health system. What we ignore is the logistics of daily life and its impact on health.

To give one example: obesity is linked to the way our communities are designed and how long we spend in our cars each day. More dramatic examples include how distance from a source of clean drinking water impact on water use, or how transport and in-house storage of that same drinking water can make all the difference between clean or contaminated water.

An even more direct link between smallest-scale logistics and health are the risks that many women and girls in developing countries (especially in refugee settings) run when collecting firewood. Here it is not even the logistics that impact on the product (firewood) and hence on health, but the logistic activity (collection) itself that endangers people’s life and health (although there is also an indirect link: the use of firewood as fuel causes air pollution).

UNHCR and the Women’s Refugee Commission recently started the Get Beyond Firewood initiative, which is trying to find safe alternatives for firewood. This is a good example of how improvement of the smallest-scale logistics can improve life and health of people in developing countries.

Related posts:

1. Emergencies and crossroads: complexities of scale and response logistics