Project Zambezi

Pre-COVID-19, there were major gaps and weaknesses in medical supply chains around the world, resulting in millions of people who lack access to basic medicines. As COVID-19 spread, the global supply and distribution of personal protective equipment (PPE) faced immense logistical challenges. Those already vulnerable to disruptions are doubly affected and millions more, including healthcare workers and patients, are at an unnecessary increased risk. 

Project Zambezi is a digital marketplace platform to address the lack in access. Our platform aggregates orders from rural and remote health facilities and leverages the infrastructure of global and local logistics partners, to deliver life-saving medical commodities worldwide. At scale, our solution can empower health facilities to manage their own supplies and their communities' needs using our platform, and provide equitable access to essential medicines and PPE in peacetime and in crisis.

Our priority is addressing the lack of access to essential medicines and other life-saving medical commodities, that is acutely experienced by rural and remote communities around the world. The logistical challenges of reaching these 'last mile' communities is exacerbated by the COVID-19 pandemic, where global supply and distribution chains are under immense pressure. 

The Access to Medicines Foundation estimate 2 billion people lack access. 

In times of crisis, if 2 billion people worldwide already lack access to medicines, how can we guarantee that all those in need will have access to PPE to fight COVID-19? In many African countries, where access to affordable, high-quality medicines remains out-of-reach, the cost of distributing medicines to health facilities and healthcare workers in rural areas is 2-3 times higher than in high-income countries. These barriers to accessing medicines at the nearest health facility force patients to travel further and buy their medicines out-of-pocket, increasing the risk of catastrophic health expenditures. Many times, patients suffer from treatable conditions and delays to treatment are detrimental. We see an urgent need in countries with such fragile medical supply chain systems, to (re)design a medicines distribution system that works for the neediest.

Our solution is a tech-enabled, public-private logistics platform to deliver essential medicines and other lifesaving medical commodities, such as PPE, when and where they are needed. The low-cost digital marketplace platform uses cloud-based technology to connect healthcare facilities with multiple medical products suppliers via the existing infrastructure of global, national, and local distribution industries.

A rural health facility in Zimbabwe for example, identifies a gap in their supplies of PPE. In addition to fighting COVID-19, political and socioeconomic instability regularly disrupt access and provisions to health facilities outside urban centres. The health facility can log on to the Project Zambezi platform and submit a request for PPE. The platform's aggregating algorithm groups the health facility's order with multiple others in Zimbabwe, or the wider region, to match the minimum order from a list of vetted suppliers. The supplier can use any of Project Zambezi's global logistics partners to process the shipment via air/land/sea transport. From the national depot in Zimbabwe, our network of local logistics partners are equipped to deliver to 'last mile' health facilities directly. All orders are tracked using blockchain and QR codes, to facilitate the timely and safe delivery via the platform.

Since inception, the Project Zambezi team have worked directly with rural and remote health facilities in pilot districts in Zimbabwe, to identify their priority medical needs and map a solution accordingly. We have strong lines of communication and engagement with the Provincial Medical Director, as well as a network of subnational health facilities and pharmacies, to ensure our solution is appropriate and acceptable, and that local communities are represented in the vision and aims of the platform. Further, we have consulted the Ministry of Health and Child Care, NatPharm (the parastatal medical supply company), and the Medicines Control Authority of Zimbabwe, to outline our goals and activities, identify areas of potential collaboration, and establish ‘ways of working’.

As we develop the solution, we have designed an online survey for health facilities to quantify and request medical supplies, to maintain an understanding and awareness of local priorities. The survey will be migrated to the platform once developed, to enable facilities to identify needs and place orders. 

The solution empowers rural and remote health facilities and healthcare workers with buying power, access to global and vetted medical suppliers, and independence from local bureaucracies. 

Our solution strongly aligns with the need for tech-enabled innovations to mitigate the impact and disruption on healthcare supply chains globally and strengthen access to health care, in terms of essential medicines and lifesaving medical commodities, for 'last mile' communities. The Project Zambezi platform leverages existing global and local logistics partners in the health and non-health sectors (for example, partnering with DHL), to plug gaps in global supply chains and provide a mechanism to connect those in need with those in business at a global to local level.

Compared to similar initiatives, such as The Coca Cola Foundations Project Last Mile and the NGO Last Mile Health, Project Zambezi's (PZ) tech-enabled marketplace platform aggregates orders, empowering rural and remote health facilities with buying power, and connects healthcare facilities with multiple vetted medical suppliers and global and local logistics partners. 

Rather than relying on one logistics partner and one supply chain management system, the PZ model a) empowers local healthcare facilities to manage their communities’ needs and their own medicines stocks, b) resists monopolisation and associated risks, c) increases competition (and thus efficiency), and d) creates a solution that is well-integrated, self-running and resilient, and replicable—both in terms of running costs and geography. The model is inherently scalable and agile, expanding to welcome new and emerging logistics partners to the platform and rapidly responding in the event of acute health crisis, or other emergencies. The platform is operable in any context and geography where there is a critical gap in access to essential and lifesaving medical products. Further, the platform can operate independently of existing bureaucratic channels whilst maintaining the infrastructure to be easily integrated into national and subnational medical distribution systems. 

Private and public sector stakeholders are increasingly turning to innovative and disruptive technologies to solve some of the world’s biggest problems and we are at the forefront of this initiative. PZ is a market-driven solution harnessing the power of digital platforms and cloud-based technology to deliver essential and lifesaving medical products where and when they are needed.

Hala Tech specialise in reverse logistics and are collaborating to adapt their software to customise an all-encompassing end-to-end logistics platform PPE delivery, including the last mile required to reach local health facilities, workers, and patients, during this crisis. The PZ solution will leverage some of these off-the-shelf components, such as unlimited distributed warehouses, stock and inventory management, real-time dispatch systems, and a logistics dashboard, in the following ways:

Short-term process change: 

• Strengthen communication systems to encourage larger bandwidth, usage and throughput, achieving user interface customization and extended communication center.

Mid-term process change: 

• Develop supply procurement systems with integration into shipping logistics, to repurpose software architecture; 
•  Sourcing suppliers with inventory items to serve the requests and automated data management to reflect accurate data on item replenishment; 
• Formulate system protocols that automate and interconnects array of services into a single (360) surveillance system; 
•  Adapt user journey of supply chain systems to incorporate health necessities.

Long-term process change (2+ months):

• Establish an ecosystem for easy integration into multi-purposed health monitoring systems via APIs, to achieve system customization and DevOps; Synthesise information into data crunches useful for impact assessment. 

We have additionally identified a digital tracking platform (Ayadee) to adapt. Ayadee uses blockchain and QR code scanning to offer secure and timely delivery for PZ's users. By customizing and integrating existing technologies, we are in a strong position to rapidly develop the unique PZ platform and interface, and maximise synergies across our collaborators and partners. 

We plan to adapt and customise existing software to build the PZ platform, leaning on the expertise and experience of our main collaborators and partners (Hala Tech, Ayadee). The technology underpinning PZ harnesses cloud-based software to power a marketplace-type model. Similar models are used by the likes of Uber and eBay, to connect consumers (i.e., the health facilities) with suppliers (i.e., our global network of vetted medical suppliers) and global and local logistics companies (i.e., our partnerships with DHL Sub-Saharan Africa, and F&B / retail wholesalers in Zimbabwe). The PZ platform will also apply an aggregating algorithm to bulk order from suppliers, to maximise cost-efficiencies. 

The PZ team has undertaken comprehensive primary market research and qualitative research, consulting national and subnational stakeholders across the public and private sectors, to identify gaps in the current distribution system for medical commodities and map out a complementary solution. As of 2016, the parastatal medicines distribution agency (NatPharm) owned 23 trucks to service the entire country, i.e. around 14.4 million people, and less than 4 trucks per province. In the pilot province we're working with, there is only 1 truck available for drug distribution. Because of the condition of the vehicles, NatPharm deliver to most rural health facilities quarterly. Local rural facilities noted that when deliveries are made, they often do not receive ordered amounts and rationing systems have to be put in place. This could be resolved if the delivery frequency was increased to monthly. Further, since the fuel hike came into effect in early 2019, drug deliveries to ‘last mile’ areas are on hold. Meanwhile, private couriers in Zimbabwe are known to reach these distances and even established distribution companies outsource their farthest deliveries to these couriers. The extra mile of drug distribution is well-known to key stakeholders and partners at the national and subnational levels, hence the broad support for the vision and aims of PZ. 

We have designed a monitoring and evaluation (M&E) plan to implement process and outcome evaluation. The aim of the M&E plan is to create the evidence-base to inform improvement and refinement of the PZ model, and to provide information for accountability and performance improvement. The main objectives include:

• To develop a mechanism for understanding and monitoring the progress of the PZ model;
• To identify and communicate bottlenecks and barriers to implementation with appropriate stakeholders;
• To give policymakers the possibility to evaluate long-term changes produced by PZ; and,
• To provide evidence on sustainable resource mobilization of needs-driven essential health solutions relevant to disease burden in low-income countries. 

The following table provides an overview of PZ outcomes (measurable changes) and outputs (goods and services being delivered) that will be monitored and measured during the pilot and early phase implementation.

PZ is focused on the subset of healthcare facilities—and the communities they serve—in rural and remote areas. First piloting in Zimbabwe, where over 68% of the population—or 11.2 million people—live in rural areas and rely on local health facilities. These health facilities are typically out-of-reach of the current medical supply chain, and disproportionately impacted by the ongoing shortages of medical supplies and lifesaving products (even if they live within distance of a local healthcare facility). In the first year of the PZ pilot, we will operate in Magwe district only (~66,000 population) and expand to neighbouring districts. By end of the second year, we will aim to cover the entire Matabeleland South province, which has a total of 143 districts (~683,000 population). In five years, we would have scaled-up to operate across Zimbabwe. Our estimates indicate that the current drug shortages in Zimbabwe impact between 5.5 million and 11.2 million people in rural and remote areas, who already suffer from a lack of access. 

Today, nearly 60% of Africans live in rural areas, which is an estimated 720 million people. At scale, we envision PZ providing a low-cost, appropriate, well-integrated and sustainable solution for 'last mile' health facilities and communities across the continent. 

In terms of the current global health crisis, we hope that putting this system in place now will firstly make PZ a tested and read-to-go solution in future public health emergencies and secondly, facilitate the distribution of future COVID-19 treatments and the vaccines, once they are available.

Our solution addresses critical gaps in medical supply chains by leveraging existing systems and infrastructure from across the private and public sectors. We have a focus—or a prioritisation of countries with already fragile and vulnerable distribution systems. The low-cost, low-resource platform is easily integrated and easily scalable, thus allowing us to serve a dual-purpose moving forward in our mission. We will deliver medicines and other essential medical products as part of a long-term integrated systems solution, whilst being sufficiently agile to fill acute gaps during public health emergencies.

Ultimately, our long-term vision is to scale the PZ solution beyond sub-Saharan Africa, to help more and more of the 2 billion people worldwide who lack access to basic medical necessities. 

Currently, we are seeking the necessary (substantial) financing to develop the PZ platform and launch the pilot. This is our major barrier. All of the components, from key collaborators and partners to support the pilot implementation of PZ in Zimbabwe, to our global and local logistics partners to deliver orders to the 'last mile' facilities and communities, to the technology and software (and developers) that will be adapted / customised to the PZ solution, and medicines and PPE suppliers, are ready to mobilise. 

Our existing global and local network have been critical to overcoming other barriers, for example legal and market barriers to importing medicines and other medical suppliers into Zimbabwe. Continued support from these in-country stakeholder groups and ongoing communication has enabled us to move forward with PZ smoothly.

In terms of financial barriers, the PZ team are committed to working as a start-up model, exploring multiple channels of public and private sector financing. We have designed a blended finance strategy to pursue. However, to date, we have not received the funding to develop the PZ platform and launch the pilot in Zimbabwe. 

The PZ team comprises three part-time staff based in Dubai, Harare, and London. The team is supported by a Board of six advisors.

The CEO of PZ, Dr Ngozi Erondu, is an infectious disease control and global public health specialist with several years of experience advising multilateral organisations and national governments on pandemic preparedness and response, with a focus on sub-Saharan Africa, the Middle East, and South East Asia. Dr Erondu is an Aspen New Voices Fellow and an Emerging Leader in Biosecurity since 2017, as well as a Trustee of Imperial Health Charity. Dr Erondu is backed by a team of advisors from Castlepines Medical Foundation, including Professor David Heymann, former Assistant Director General of the WHO, and has led numerous research teams to understand gaps in sub-Saharan Africa, especially in Zimbabwe.

We are able to tap into a vast pool of knowledge, experience, and expertise, to help us 1) deploy and scale our solution in the current challenging climate, and 2) navigate the official launch of our solution in countries where there is the most need. We have strong working relationships with the Centre on Global Health Security at Chatham House, the London School of Hygiene and Tropical Medicine, the WHO HQ and Africa, the Africa and US Centres for Disease Control, and National Public Health Institutes in Nigeria, Ethiopia, Zimbabwe, Chad, Guinea, Kenya, Tanzania, Rwanda, Afghanistan, Pakistan, and several other low- and middle-income countries.

These relationships and resources enable us to cost-effectively mobilise to deliver a solution that addresses a huge unmet need and we will continue to seek funding, to support long-term implementation and scale-up. 

We have agreed collaborations and partnerships with DHL Sub-Saharan Africa, on providing the global and local logistics solutions, as well as Delta Beverages in Zimbabwe, to support ground transport to 'last mile' health facilities. On the technology front, we have partnerships with Hala Tech to customise the cloud-based platform for PZ and with Ayadee - a start-up providing global tracking solutions using blockchain and QR scanning - to support the pilot PZ programme. 

Our business model is based on social enterprise. The primary beneficiaries of PZ’s solution are rural communities, who represent 68% of Zimbabwe's population, and are currently the most under-served and disadvantaged in terms of access.

In 2017, the Zimbabwe National Statistics Agency estimated that 30.3% of the rural population or 3.3 million people live in extreme poverty, i.e. on less than $1.90 / day (2011 PPP). Extreme poverty in Zimbabwe rose from 29% in 2018 to 34% in 2019 – an increase to 5.7 million people – and will continue to rise into 2020. Due to hyperinflation in 2018 and 2019, access to health care and other critical services remain elusive for many Zimbabweans. 

The PZ solution democratises access to essential medicines and other lifesaving medical commodities, i.e. via the PZ platform, any health facility has the opportunity to source medicines or PEE for their patients and the wider community they serve. Further, the platform aggregates orders to get the best price match for facilities that may not be resource-rich or don't typically have buying power. 

By partnering with established logistics companies, the solution maximises existing private-sector infrastructure and efficiencies, as well as helps overcome some of the bureaucratic barriers to public sector distribution systems. The solution brings together the best of business with the ambitions and goals of global public health and health security, reinvesting profits into the local health facilities and communities to further increase access to essential medicines and other lifesaving medical commodities, such as PPE.

The PZ solution operates on a competitive flat rate per delivery, irrespective of distance and (most) weights. This charge covers the cost of PZ operations and a driver incentive programme. The clients, i.e. government clinics, government entities on behalf of clinics, private hospitals, etc. would bear this cost for each delivery ordered. At scale, the PZ team will provide logistical and technical oversight, as well as continued communication with the partners, but the main gears of this business are within the digital platform that will be used by distributors and clinics to monitor and track medicines. This allows for reduced reliance on human resources at scale.

We believe the Solve Challenge is a platform to connect with like-minded individuals who want to make a sustainable impact on humanity and solve some of the world's most intractable challenges. The monetary and non-monetary support offered is an immense attraction to the Solve Challenge, and the PZ team are at a critical junction in our start-up journey where receiving both types of support could really springboard our digital platform and realise our vision and goals. 

We are in the infancy of our start-up trajectory and welcome partnerships that we can learn from, collaborate with, and synergise missions. This is an exciting stage for our platform and we seek greater exposure to different business model types, solution technologies, and funding / revenue models for social enterprises. 

The PZ solution aims to equip health facilities, workers, and patients with the necessary life-saving PPE to strengthen our global response to COVID-19 and increase the resilience of health systems and societies worldwide. The long-term impact is manifold: at a systems level, the solution encourages greater collaboration and alignment across sectors, to build trust in times of crisis and bridge capacities for rapid mobilisation. We envision the solution becoming an integral part of health systems' toolkits for pandemic preparedness and response. At a local level, the solution provides a platform to empower rural and remote health facilities and healthcare workers to demand access to the same life-saving equipment as resource-rich countries. This solution is an opportunity to equalise access and create a 'buyer's monopoly' both in crisis and in peace time. The combination of our long-term and short-term impact strongly aligns with the objectives and milestones of the SDGs.