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The missing link in African health systems? The auto mechanic

A Riders healthcare worker. Photo: <a href="">Riders for Health</a>
A Riders healthcare worker. Photo: Riders for Health

Twenty-four years ago, Barry and Andrea Coleman saw women in labor being carted to hospital in wheelbarrows. Today their organisation, Riders for Health, mobilizes 3000 health workers with reliable transportation and ensures 12 million Africans have access to health care.

In Sub-Saharan Africa, sick or pregnant people who live more than five miles away from a health centre have lower rates of survival than those who live close to a clinic. The Colemans witnessed this tragic reality firsthand when they visited Africa in the late 1980s. Given the clear need for reliable healthcare transportation, they were dismayed to see relatively new aid agency motorbikes lying abandoned at the roadside for want of basic repairs. The couple, who share a background in professional motorbike racing, realized they could apply their skills to the problems they had encountered. So they re-mortgaged their house and set up Riders for Health.

Organisations working in Africa often lack the funding and expertise needed to run vehicles correctly in hostile environments. Riders addresses this gap. They employ over 300 staff in the Gambia, Zambia, Lesotho, Kenya, Zimbabwe and Nigeria and manage 1300 healthcare vehicles. Their technicians travel to remote locations to service vehicles. The organisation also trains healthcare workers to ride safely and carry out basic maintenance checks. Additionally, they offer a courier service that transports blood and other medical samples between rural clinics and urban laboratories.

Riders for Health is a non-profit organisation but, in order to ensure economic sustainability, they have developed entrepreneurial solutions that tap into the power of the marketplace. They charge for their services on a cost per kilometer basis. Although initially focused on maintaining vehicles owned by healthcare organizations, more recently they have developed an innovative leasing system. This program was successfully implemented in the Gambia in 2009 where they now lease 240 of their own vehicles to the Ministry of Health. In its first year of operation the fleet covered 2.2 million km and brought about a 32 percent increase in health centers scheduling outreach clinics in rural communities. Thanks to the leasing model, the Gambia is the first country in Africa capable of delivering healthcare to its entire population.

From a healthcare perspective, Riders’ achievements speak for themselves. With reliable transportation, a clinician can help four times the number of people than they could without. So, for example, after they first set up in the Gambia in 2002, diarrhea diagnoses increased by 261 percent and malaria diagnoses by 55 percent, compared to 2001. In terms of poverty alleviation, this is critical. Barry Coleman puts it simply: "You need a healthy population if you are going to have the slightest cat in hell's chance of doing anything about poverty."

From an economic perspective, regularly maintained vehicles are also more cost-effective. A 2005 OC&C due diligence report found that in the Gambia, the annual fleet maintenance cost per patient treated was 24 percent less with a Riders-managed fleet than an unmanaged fleet.

Barry Coleman jokes that "changing oil filters so vehicles don’t break is very far down the [development community's] intellectual pecking order.” But as financial guru Alvin Hall points out his TV program about Riders, it is the simplicity of their approach that is its strength: "It's not rocket science. And it’s not sexy. But it saves lives."

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