Mitigating Demand-Side Risks of Vaccine Delivery at the Last-Mile in Rural Areas

By Prabhat Labh – CEO, Grameen Foundation India

As India unrolls one of the largest immunization drives in the history, we watch with bated breath – the aim of deploying COVID-19 vaccines to cover atleast a fourth of its citizen by the end of 2021 is within our grasp. The mammoth task of reaching over 30 Crore beneficiaries in the first phase, including over one crore health workers and over 2 Crore front-line workers will test our capabilities in not just segmented last-mile delivery and supply chain management prowess, but also a seamless coordination between multiple public sector and private sector capabilities, and mobilization of relevant resources in coordination with various stakeholders, governance entities, and community institutions.

With 27,000 cold chain points, 76,000 cold chain equipment, 700 reefer vans, 55,000 cold chain handlers, and 2.5 million health workers as part of its vaccine logistics network, we have seen a lot of media coverage and expert discussions on the supply side of the vaccine delivery value chain. With the integrated Co-Win platform governing multiple aspects of the value chain we are witnessing an unprecedented and ambitious effort of leveraging the government-enabled digital stack – be it the Aadhaar authentication, or the use of DigiLocker for document verification.

At the same time, we also see it imperative that demand-side gaps, especially at the last-mile amongst rural communities is addressed. Based on the conversations with our field staff and other stakeholders on the ground, it is pertinent for us to focus on the following issues on the demand-side of things:

  1. Bridging the awareness gap amongst rural communities: Awareness generation amongst community members on proper vaccination procedures and practices.
  2. Effective targeting of vaccine delivery: Targeted data collection and clustering of relevant priority patients
  3. Overcome technology divide amongst rural communities: Enabling the technology stack with support in Aadhaar Authentication and DigiLocker based document verification.
  4. Resource Convergence: Convergence of front-line workers and various community institutions to enable multi-faceted outreach across target demographics and socio-economic clusters.
  5. Continued collaboration amongst CBOs, public sector institutions, and private sector players: As seen with the initial days of the COVID-19 pandemic, greater collaboration of public sector and private sector entities is critical to support the efforts of Community-Based Organizations to reach the last-mile.

In addressing these points in establishing effective systems and processes to reach the last-mile communities, one critical component underpinning the success of such efforts will be a cadre of well-trained digitally-enabled last-mile changemakers in the community. In this regard, we see synergies with our Grameen Mittra network (and other such last mile networks of trusted community agents) deployed by Grameen Foundation India.

Grameen Mittra Model by Grameen Foundation India

In the last couple of years, Grameen Foundation India has built a cadre of community-led last-mile digitally-enabled female changemakers across various locations through many of the projects undertaken by us. Meaning “Friend of the Village”, Grameen Mittras are empowered self-employed women, providing financial education and customer onboarding and assisted transaction services towards financial, livelihood, and non-financial products in their communities. These Grameen Mittra’s bridge the awareness gap within the community, providing financial literacy training to the members of the community. They also play a crucial role in enabling linkages for people towards savings, insurance, utility bill payments, and government schemes.

We engage the communities in the locations we work in to identify these Grameen Mittras who form the backbone of our efforts. Capacity building of these Grameen Mittras is undertaken by leveraging our award-winning digital platform called G-LEAP (Grameen Learning Platform). Grameen Mittras are linked to service providers and business opportunities that have been vetted and require low capital investment. They receive training to ensure they have the requisite knowledge and skills that will enable them to excel as social entrepreneurs while growing their businesses and building rapport with end-clients.

Diagram: The Grameen Mittra Model

Having the traditional and customized location-specific learning, these Grameen Mittras work with both the people and the institutions within the communities to provide a balanced and holistic outlook towards improved economic outcomes.

  • Supply Side Benefits: On the supply side, the Grameen Mittras connect the communities to financial and non- financial services, government-to-citizen schemes, health and nutrition products and inputs for enhancing livelihoods.
  • Demand Side Benefits: On the demand side, they work with rural enterprise ecosystem (MSME’s, merchants, Cooperatives) and local institutions (SHGs, JLGs) and individuals to build awareness, build trust to drive adoption of various products and services.

Grameen Mittra Model and its Synergies with Improving Demand-Side Efficiencies in Vaccine Delivery

We see a lot of synergies which can be leveraged by deploying the Grameen Mittras for an effective and efficient vaccine delivery, especially in plugging in the demand side gaps.

  1. Bridging the Awareness and Availability Gap at the final-mile frontier – As Grameen Mittras have strong ties to the community and enjoy the trust of the households through their doorstep delivery of services and consistent community engagement, they are in a unique position to spread awareness about accurate COVID-19 vaccine protocols and availing the efforts of the government to these communities. A stronger IEC campaign with collaborative training program with the district-level health officials can also be envisioned to actualize this.
  2. Targeted Data Collection and On-Ground Support in Targeted Vaccine Delivery: Grameen Mittras can double up as effective data collectors with minimum support, proper incentives, and low-touch capacity-building efforts. We have seen some success in this model being deployed for data collection in supporting research studies undertaken by University of Pennsylvania, and also in baseline data collection for our projects.
  3. Enabling Technology Stack at the last-mile: Many households will not have access to Digi-Locker based services, or Aadhaar-mobile-bank account linkage, or even the comfort in availing such services. Grameen Mittras through their engagement with these community members in financial and non-financial services can add these essential tools required to their basket of products and services, and help bridge the access gap.
  4. Convergence with other frontline workers, community-based institutions, and government schemes: With Grameen Mittras having demand side as well as supply-side engagement, they can be pillars of driving the convergence of various government schemes, local-level institutions, and relevant stakeholders to bring about effectiveness in vaccine delivery. These Grameen Mittras can mobilize the SHGs, local-level entrepreneurs and MSME sector stakeholders, as well as other institutions in adopting massive vaccination drives reaching out to people affiliated to them. This will bring about resource efficiencies, as well as build a stronger on-ground network and presence, bringing about network effects driving adoption of the vaccination drives.

Currently, our network of over 630 Grameen Mittras spread across multiple districts, have been able to reach out to over a million beneficiaries. In the next five years, we aim to expand the Grameen Mittra Network to 10,000 Agents covering 50 districts across five states. Besides the creation of self-employment for 10,000 women, this will create positive economic impacts through livelihoods enhancement, financial inclusion and increased resilience for 25 million end customers. We aim to create a sustainable self-supporting model through partnerships with multiple organizations to improve the basket of products and services to be delivered by the network of Grameen Mittras in the last mile, enabling their communities to avail and access the best quality, and cost-effective options possible.

We are expanding our efforts to reach out to relevant stakeholders to explore these synergies and chart a way forward. Being true to our human-centered approach of program design and implementation, we believe that creating effectiveness and efficiencies on the demand-side keeping the last-mile rural community members at the center will unlock resource efficiencies, and help in achieving the aim of reaching out to cover every single citizen with vaccinations as well as other essential services.

Drop-in an email at asutar@grameenfoundation.in to know more about the Grameen Mittra model and explore synergies in scaling up our work in promoting these digitally-enabled last-mile changemakers in the community.

 

 

Grameen Foundation India

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