Frontline Perspectives: For Nabeel Ahmad Maqbool, delivering to the last mile means much more than logistics

Just months before COVID-19 hit, Nabeel Ahmad Maqbool had moved from GHSC-PSM’s provincial office in Punjab, Pakistan’s largest province, to the field office in Islamabad in late 2019. “I started as director of vaccine preventable infectious diseases,” a unique portfolio that doesn't exist in other GHSC-PSM country offices,” under the project’s maternal, newborn and child health program.?

Having worked with USAID-funded projects since 2013, Nabeel had a unique mix of experience to lead the project’s support for COVID-19 response. “When COVID came, I had a little edge in that I had worked in the field, and I had worked at the policy level and the planning level.”?

Nabeel is quick to point out that, in one way or another, everyone with GHSC-PSM in Pakistan has helped lead COVID-19 response.??

While procurement, warehousing and distribution of health commodities have been important parts of GHSC-PSM’s support, Nabeel believes, “The automation of supply chain processes and digitization are the success stories that we are famous for. We were the pioneers of the PPE (personal protective equipment) calculator, which we developed for calculating the demand of any specific hospital. We developed a generic module that any hospital in Pakistan or any health system in Pakistan can put in just a few figures – number of beds, number of healthcare providers and number of patient influx, and they would get their demand.”?

The PPE forecasting calculator gained international recognition. The I+ Solutions Academy in the Netherlands adapted it for an online English, French, Spanish, and Portuguese course. "Thousands of people have used the PPE calculator, and they have trained individuals worldwide on how to use it".

"We developed a COVID-19 logistics management information system that is built on Pakistan's well-articulated LMIS infrastructure, which can easily incorporate any new products. The system is hosted by the National Telecommunication Corporation and was configured to add COVID-19 products for government agencies like the National Disaster Management Authority and the Ministry of National Health Services. All donations received by the federal government are managed through the COVID-19 LMIS. Executive dashboards at the national and provincial level help supply chain managers in planning procurement and other necessary actions to ensure a consistent supply of commodities.”

By the time COVID-19 vaccines became available, Nabeel and the team were prepared. “We did the same thing for vaccines, which are also being managed through the COVID-19 LMIS.” Now the team is working on a new initiative. “We have just finalized the design of the oxygen MIS to provide visibility to the government of Pakistan for oxygen stocks at the health facility level.”?

“Thanks to COVID-19, we have leaped ten years ahead in our efforts to implement digital technology solutions. Digital technology can play a vital role in managing any outbreak, any disease, any public health emergency or natural disaster.” Through digital technology, “you see the power of information.”?

Another unique aspect of USAID’s and GHSC-PSM’s support in Pakistan was the added effort to deliver to the last mile. For Nabeel, this was a matter of quality assurance, “to ensure that the support is reaching the people it is meant for.” While many donors only deliver centrally, “USAID wanted to deliver at the doorstep of the community. So, we delivered each of the commodities to the health facility level.”

Ventilator delivery presented multiple challenges during the peak of COVID-19. "We had to figure out which private-sector biomedical and logistics partner would be best suited to transport the ventilators to the 68 facilities. We were planning to air lift some of them since there were hard to reach areas that needed support. Our provincial teams worked with me to make that coordination happen.”?

The team continues to deliver commodities to the last mile. “Recently we delivered $6 million of USAID donated oxygen ecosystem commodities to 163 hospitals. We directly handed them over to the health facility staff.”?

Delivering to the last mile also meant ensuring that people know how to use the equipment arriving on their doorsteps. “The company that provided ventilators was an American company. They have a local agent here, and we took them to all those 68 facilities. They provided hands-on training to the hospital personnel on how to use and apply the ventilators on patients.”?

The impact of USAID investments and GHSC-PSM’s efforts to support the local oxygen ecosystem will be felt for years to come, providing new capacity to Pakistan’s public health system. “Concentrators and ventilators are going to stay there in the hospitals and in the health system. This is the first time in history that we are providing these high-flow concentrators that give oxygen to five patients at one time.”?

Four USAID-donated mobile biosafety level two labs that the team delivered to help test for COVID-19 will also have a long-term impact. “These are complete virology labs. In upcoming epidemics, emergencies or infectious diseases outbreaks, they can go to the impacted part of the country. We witnessed that last year when there was a catastrophic flood in two provinces and outbreaks of malaria, dengue, influenza, and COVID. The government was quick to route two of those labs to the flood affected areas and they were stationed there for months.”?

Nabeel believes there is a lesson to be learned from the past three years. “COVID has given us a wake up call to work on readiness. Readiness is important and diseases are now a global security issue.”?