Vaccine-preventable diseases kill 2.4 million children annually and leave millions more severely impaired despite the existence of low-cost vaccines that are readily available in rich countries. In response, the world has applied tremendous amounts of effort, not only to acquire existing vaccines, but also to develop new, more powerful vaccines for every child, no matter where he or she lives.

Huge progress has been made towards this goal of global equity, yet the health systems in many of the poorest countries remain incapable of handling the increases in throughput required to deliver these vaccines, especially to remote communities. A funnel effect is occurring where billions of dollars of investment are piling up due to the limited capacity of health systems to deliver these vaccines.

The problem is most acute at the lower levels of the health system or “last mile” due to the lack of support for frontline health workers, inefficiency of supply chains and other systems upon which these workers depend, weak information systems that could otherwise illuminate system performance, and missing local infrastructure needed to support healthcare delivery. Ignoring this severe bottleneck will render the billions of dollars that have been and will be devoted to vaccine discovery, development and procurement a profoundly diminished investment.

From many years of experience working in remote areas at the lowest levels of the health system, we at VillageReach have learned that any improvements to existing health systems must recognize the level of local resources, capacity and infrastructure that are available. Too often, those of us from the rich countries design improvements for health systems in poor countries based on what we envision should be – rather than what can be – given the local context.

By working directly with local ministry of health officials and local communities we develop, field test, refine and document new approaches that address key barriers of healthcare delivery at the last mile. We have learned the importance of a comprehensive approach that engages the private sector, improves data availability, and increases health worker capacity. This approach results in proven system innovations that have greatly increased the availability of vaccines for children living in the hardest-to-reach areas at a significant reduction in government operating costs.

Success, however, is judged not only by producing proven system innovations, but also by their longevity and the number of children positively affected. Many of us are working towards a common goal, but because of our organization’s modest capacity and the scope of the problem we seek to address, we must find ways to leverage our work through partners such that many other organizations sustain the improvements and take them to scale.

To achieve those goals, we work with the broader global health community to adopt and adapt these proven system innovations. Through this approach, social entrepreneurs are able to create lasting change on a far larger scale than what is possible with their own, limited resources.

To deliver the promise of vaccines to all children no matter where they live, we must start at the last mile with an understanding of what can be done – and then work together to build health systems that will reach every child.

Author: Allen Wilcox is Chief Executive Officer of VillageReach, Mozambique and a Schwab Foundation Social Entrepreneur

Image: Women wait for vaccinations by a team from UNICEF (Ivory Coast) at St. Ambrose church in Angree, Abidjan March 9, 2011 REUTERS/Thierry Gouegnon