What is true impact?
Logistimo is on a mission to ensure availability of essential goods in rural and underserved urban areas. Essential goods include all commodities that people rely on for health and livelihood, including food, medicines, agricultural inputs, textiles, energy products, and so on. Such goods are not easily available or accessible in such areas, given various challenges of infrastructure and resources. These environments can be referred to as ‘resource -constrained’ environments, where both human capacity and infrastructure are limited. Logistimo optimizes rural and semi-urban supply chains and transportation logistics using mobile and cloud-based technologies. We offer software-as-a-service which distributors, warehouse managers, retailers, and transporters use to accomplish their tasks. The service embodies a principle of bottom-up empowerment, wherein it leverages user-friendly mobile applications that adapt according to the capacity of an individual, thereby enabling one to effectively use data and analytics and improve performance. Logistimo started small in the public health sector, empowering a few primary health care centers in Karnataka, India and eventually scaled across India and 6 other countries in Africa, covering over 30,000 health centers. All these countries experienced improved availability of commodities (> 95%) with strong adoption (data reporting rates >90%).
As a social enterprise, and as participants in it, we always wonder, “What is the impact we’ve enabled?” It is also a question asked by our funders, be it impact investors or philanthropic foundations. Typically, impact is measured by metrics, some quantifiable and many which can only be qualified. In the case of supply chains, one important metric is ‘availability of commodities’ (the percentage of time a product was available), supported by adoption metrics (such as data reporting rate), both of which are quantifiable. User happiness or environmental impact, for instance, are qualifiable but hard to quantify accurately.
The question arises: “How can we enable change to achieve impacts and measure them using an acceptable framework?” To achieve any change, one needs insight into the current problems in the supply chain, which arises only if there was sufficient data from the last-mile (i.e. the service delivery points where consumption occurs). Under the circumstances, it is a tall order to transform public health supply chains in low-and-middle income countries to achieve this. There are systemic challenges ranging from lack of political will, bureaucracy, limited funding, lack of procedures, limited human capacity, poor infrastructure and, most importantly, no culture of data recording or use. Such a change takes patient effort and time. The typical model of bringing about a change involves bringing an intervention supported by information technology. Many interventions in public health supply chains have been top-down, with limited success, due to a lack of adoption at the last-mile. While software was deployed, the kind of data needed to gain insights never came, or even if so, significantly lacked in quality, thereby rendering it useless.
At Logistimo, we took an empathetic but a difficult path — enabling change from the bottom-up by empowering the human value chain, where people’s self-efficacy and self-confidence improves to achieve better performance. It is a human-centric approach, that tends to improve human capacity and awareness, as much as it is material-centric, that tends to optimize product availability and supply chain efficiency. We fully applied ourselves, working in the field, understanding people and all the constraints in the supply chain, human resources and the digital infrastructure. It required deep design thinking, and a rigorous data-driven approach to iteratively evolve service design. It was clear that it required a strong service-orientation and we began to offer supply chain management software as a service (SaaS), with a strong spirit of service, that mindfully employed user-centric design, empathetic process re-engineering, social engineering and communication design. It started small, in a few primary health care centers (PHCs), and took a few years before a simple and refined model evolved. It went through its phases of software development, deployment, adoption, data quality improvement and eventually improved supply chain performance. Amongst a handful of PHCs in India, we could quantify impact, wherein the availability of routine vaccines given to children increased from 65% to 99% over a period of fourteen months. This was our first view of measurable impact using data of the highest quality. However, it was in a small setting, and scaling it was the next imperative. After all, we were measuring impact in numbers, and hence bigger the scale, more the impact.
Fueled by a quantified success uncommon in such environments, the service organically spread to an entire district (of Chamarajanagar, Karnataka), was piloted in a couple of districts in Uttar Pradesh, and eventually scaled to the entire country covering over 24,000 PHCs in the form of eVIN (Electronic Vaccine Intelligence Network). Each stage of scale posed a new set of challenges, which we vociferously overcame, while fiercely sticking to the principles of bottom-up empowerment and service-orientation — at times, against all odds. Independent studies revealed that high availability (>96%) and data quality (>95%) were achieved at that scale. This was arguably a huge impact. However, it was still in one country. It was natural to believe that there were many countries in need of a similar solution. Pilots had already started in a couple of countries in Africa that revealed its value. The constraints were remarkably similar and the system was highly configurable to adapt to the variations those environments presented. Soon, it made in-roads to six countries in Africa, starting with pilots and scaling across multiple geographies. Supply chain challenges in Africa were largely similar, but there were significant systemic challenges including politics, bureaucracy, competing agendas, lack of funding and inertia to adopt novel service models (such as SaaS). This slowed down progress, even as children and adults continued to suffer with limited access. However, in some countries, people at the facilities and districts found value in the service, adopted it and were able to improve supply chain performance. The improvements were quantifiable, and it sustained in small pockets. They were generous in their feedback to improve the system, and we heard them loud and clear. This was a story of change and a triumph of the people operating the supply chain — an impact in its own right. Over time, it matured into top-down efforts to scale country-wide across a few countries, each with a unique set of challenges. During this time, a new dimension of scale evolved — the service not only scaled vertically within a supply chain, but also horizontally across other supply chain verticals such as reproductive health, essential drugs, TB, AIDS/HIV and Malaria. Gradually it evolved to support the entire health supply chain of a country, integrated horizontally and vertically, managing over a million inventory items across facilities. Even at this scale, there was reasonable adoption and data quality, although different facilities took variable times to achieve it, while some still continue to struggle. Achieving high quality and impacts at this scale across the entire health ecosystem in a country is challenging. However, we are happy to note that the core principles underlying the service continue to work effectively.
Reaching increasing numbers and dimensions of scale was exhilarating. We did feel a stronger sense of impact, although it came diluted — more through statistics, rather than grounded stories and anecdotes. However, sustaining the impacts posed the next level of challenges, some of them quite unexpected. Even where strong impact was demonstrated, it could not scale since funding ran out. Complex legal and contractual issues resulted in countries relegating to age-old, top-down models that had not demonstrated quantified impact, or may continue to find it difficult to do so — given their design has simply not factored ground realities or lacks the necessary service-orientation to deal with emerging ones. Competing agendas and conflicting preferences on systems and approaches led to stalling and subsequently choice of a different software. In many of these cases, the intervention was simply treated as a software project rather than recognizing the need for a transformative service aided by software. Clearly, what is impactful and scales up, can also scale down. Does this mean that our impact is now lesser? If we continue to measure impact by numbers, it will appear that way.
The question is: “What then is true impact?” It ought to be something that is everlasting, that transcends numbers and time. What could this be? Is it the successful deployment and adoption of the software? Is it the data? Is it the insight enabled by data? Or is it the action taken against that insight? From my perspective, the true impact is the change that the people in the supply chain went through to build a behavior of data recording and use, thereby improving their ability to understand problems and collaboratively solve them. This always results in sustained improvements in supply chain performance. Whenever we asked our users for feedback about the software, they would say, “This data helps me provide a better service to my beneficiaries, and I am being recognized for it”. The software was invisible in their response. It was just about the insight enabled by the data that allowed them to act in time. It had increased their awareness and enabled them to perform better. Now, this change is true impact. It had enabled a culture of data recording and use. This kind of change carries forward well beyond our service and ourselves, and is independent of the software, data, or the supply chain they operate in. It transcends all material outcomes and is independent of whether our service scales up or scales down. Human behavior changes enabled through our service is empowering and is the true impact. After all, it makes our users and those they serve happy. What could bring us more joy!
As one can imagine, this experience has transformed us internally. It has strengthened our core principles, made us more resilient, given us a deeper insight into complex problems, helped us understand human and community behavior, driven us to innovate, expanded our personal capacities and motivated us to serve better. Most importantly, it has helped us better realize the true nature of impact.