Reaching the unreached

Reaching the unreached

United Kingdom
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Using vehicles in Africa is not a new idea. Riders for Health’s innovation lies in challenging assumptions about the use of vehicles for healthcare delivery, and systematically transforming access to healthcare for millions of people in rural, African communities, previously been isolated by distance and terrain.

Hitherto, the lack of infrastructure and the harsh conditions in Africa have led many to conclude that vehicles are doomed in such an environment. Millions of dollars have been wasted on vehicles that are unmanaged. Without appropriate maintenance, a vehicle will last for maybe a year but will then breakdown unpredictably and expensively. Trained public health workers are forced to travel by foot to reach the people in their care, negating their ability to do their job effectively. People in rural areas have to leave their communities and walk for many kilometres to access even the most basic healthcare. No matter how much funding is poured into development programs like the provision of medical care, improved food technologies or improved water and sanitation services, such interventions will fail if there is no transportation available to reach the people.

Riders disrupts this isolation using a locally-run infrastructure and management system for vehicles used in the delivery of healthcare and services. The system is known as Transport Resource Management (TRM). It changes attitudes and behaviour around the use of vehicles, creating a culture of preventive maintenance and a systematic approach to vehicle management.

We work with agencies who reach out to rural communities. They benefit by being able to achieve their objectives and budget accurately for the costs of reliable transportation. Health workers benefit because, once mobilized, they can achieve their work targets and also become healthier themselves by conserving energy. And, ultimately, millions of people in rural communities benefit from regular, reliable access basic healthcare.

About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity

Service/process

Year the initiative began (yyyy)

1988

Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?

Health care not consumer friendly

Which of the principles is the primary focus of your work?

Democratize access

If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:

This field has not been completed

Innovation
Define the innovation

Using vehicles in Africa is not a new idea. Riders for Health’s innovation lies in challenging assumptions about the use of vehicles for healthcare delivery, and systematically transforming access to healthcare for millions of people in rural, African communities, previously been isolated by distance and terrain.

Hitherto, the lack of infrastructure and the harsh conditions in Africa have led many to conclude that vehicles are doomed in such an environment. Millions of dollars have been wasted on vehicles that are unmanaged. Without appropriate maintenance, a vehicle will last for maybe a year but will then breakdown unpredictably and expensively. Trained public health workers are forced to travel by foot to reach the people in their care, negating their ability to do their job effectively. People in rural areas have to leave their communities and walk for many kilometres to access even the most basic healthcare. No matter how much funding is poured into development programs like the provision of medical care, improved food technologies or improved water and sanitation services, such interventions will fail if there is no transportation available to reach the people.

Riders disrupts this isolation using a locally-run infrastructure and management system for vehicles used in the delivery of healthcare and services. The system is known as Transport Resource Management (TRM). It changes attitudes and behaviour around the use of vehicles, creating a culture of preventive maintenance and a systematic approach to vehicle management.

We work with agencies who reach out to rural communities. They benefit by being able to achieve their objectives and budget accurately for the costs of reliable transportation. Health workers benefit because, once mobilized, they can achieve their work targets and also become healthier themselves by conserving energy. And, ultimately, millions of people in rural communities benefit from regular, reliable access basic healthcare.

Context for Disruption:

espite a stunning plethora of medical breakthroughs in the last hundred years, people on the continent of Africa continue to die in epidemic proportions. There is no single obstacle to solving this situation, but one issue stands out. Mobility – the ability to reach people in rural communities.

In Africa, one health worker can be responsible for reaching up to 20,000 people, scattered across hundreds of kilometres of hostile terrain. Trying to deliver even the most basic healthcare – bed nets, condoms, health education – on foot or by bicycle is virtually impossible.

Typically, major cities have a good infrastructure with fuel stations, dealerships and workshops. But the rural areas are neglected. The world of development is full of organizations and agencies who specialize in health. They should, as they do in every other part of the world, take transportation for granted. It should be simply a means of reaching people whose lives are in jeopardy. For the majority of people living in rural areas, the mobility of public health workers means the difference between receiving health care and services and not receiving them. And therefore it is too often the difference between life and death.

Riders’ work is a catalyst, without which established solutions to improving health and saving lives fail to reach the people who need them, and without which new (and often expensive) innovations and initiatives will be tragically wasted.

Riders’ system challenges the tradition of short-term, project-based, single disease-focussed programmes – usually delivered by Western agencies – and enables it to be replaced by a locally-managed system which focuses on delivering a broad programme of preventive public healthcare measures, directly to communities.

Delivery Model

Riders’ Transport Resource Management system is an appropriate, replicable and sustainable infrastructure in which vehicles can be managed in harsh conditions. It incorporates training in safe riding/driving and planned, preventive maintenance procedures, supported by Riders technicians, who deliver outreach servicing from strategically placed workshops.

Riders’ outreach technicians arrange to meet groups of health workers in the community on a monthly basis to service their vehicles. Parts are replaced according to the mileage covered and are ordered on an ‘in-time’ basis so that valuable resources are not tied up in consumables.

Riders trains public health workers, community nurses, midwives, epidemiologists and other users to ride/drive and to carry out daily maintenance checks. They are trained to keep strict daily log-books to record fuel used and distance traveled. This allows Riders to calculate the exact costs for each kilometer covered. Defensive driving is vital but good riding/driving also conserves the life of the vehicle.

Riders is the only organization worldwide able to calculate and provide the exact costs per kilometer (cpk) for the vehicles it runs. Based on these calculations, it can advise which vehicles are most appropriate for any environment, and and fees are charged for its services – on a non-profit basis – based on this cpk.

Riders has three programmes operating nationally in the Gambia, Nigeria and Zimbabwe, and smaller projects working with partners in Kenya and Tanzania. New programmes in Lesotho and Mozambique are planned for 2007. To maintain and enhance the standards set in the TRM system and to build the vehicle maintenance ‘culture’, Riders established the International Academy of Vehicle Management (IAVM) in Harare, Zimbabwe. Since its launch in 2002, over 1000 delegates from across Africa have received training in safe riding and driving, vehicle maintenance and fleet management.

Key Operational Partnerships

Partnerships and collaboration with people working at community level are integral to Riders’ model. By working together to embed the culture of vehicle maintenance in Africa, and to build the local capacity needed to implement the Riders’ system, the responsibility and benefits of uplifting health in rural communities are shared equally by Riders, the agencies we mobilise and the people living in those communities.

Our work underpins the work of any health-related organisation that serves rural communities, giving them predictable and reliable access to their beneficiaries. Our local staff work in close collaboration with public health workers, NGOs and locally-run community organisations, providing reliable mobility to enable these groups to carry out their activities regularly and reliably. Key partners include the ministries of health in The Gambia and Zimbabwe, UN agencies, international organisations such as VSO, and in-country NGOs such as the Farm Orphan Support Trust (Zimbabwe) and the Farm Community Trust of Zimbabwe.

Impact
Financial Model

Riders' programs are based on the model of social entrepreneurship and are designed to become self-sustaining.

Riders is the only organisation worldwide able to calculate the exact cost-per-kilometre for the vehicles it runs, taking account of maintenance interventions, replacement tyres, fuel, and management and logistics costs. Parts are replaced according to the mileage covered and are ordered on an ‘in-time’ basis so that valuable resources are not tied up in consumables. Fees calculated using the cost-per-kilometre calculator are then charged to our partners (at a non-profit rate) for the transport management services provided.

Additional support for growth and development is provided by Riders UK, from funds generated in the UK, Europe and the USA (see ‘sources of revenue’, below).

What is your annual operating budget?

$7,000,000

What are your current sources of revenue? (please list any sources that are foundation grants)

In addition to the income generated within Riders’ programs themselves, funding was initially raised within the international motorcycling community. Fundraising initiatives have now developed at motorcycling events in the UK, USA and Europe, including providing services such as a helmet cloakroom for bikers, and holding auctions of exclusive racing memorabilia. Sources of funding have also now increased and include social enterprise funders such as the Skoll Foundation, Rotary International, trusts and foundations, and individual donors.

Effectiveness

A recent, independent ‘due diligence’ evaluation carried out on Riders’ programs found that our work results in significant health and economic benefits and increased health worker outreach:

More than 10.8 million people living in remote, impoverished villages across rural Africa are now accessing the kind of primary healthcare services taken for granted by the developed world. More than 1,200 vehicles are being managed. 900 mobilized public health nurses are covering four times the area and four times the volume of people than nurses traveling on foot. Remote communities are visited 13 times more frequently per month. Dramatic increase in number of cases being diagnosed and treated: 261% more cases of diarrhoea / 75% more cases of acute respiratory infection / 55% more cases of malaria. 73% of infants in the Gambia are now fully immunized. 21% decline in malaria death rate. Dramatic reduction in annual fleet maintenance costs: 62% reduction per thousand people reached by health workers in Zimbabwe / 24% reduction per person treated per month by nurses at outreach clinics in The Gambia.

Since its opening in 2002, over 1000 delegates from across Africa have trained at Riders’ International Academy of Vehicle Management in Zimbabwe, more than 80 of whom also benefited from the bursary scheme for small organisations with limited resources.

The proven results of Riders’ innovation have influenced a number of institutions – including the ministries of health in the Gambia, Zimbabwe and Mozambique, UN agencies and both international and local NGOs – to make a significant change in their policies and adopt Riders’ system of preventive maintenance. The skills of over 200 local people are also being enhanced continually to manage Riders’ programs, building the culture of preventive maintenance and cost-effective vehicle management within their communities.

Which element of the program proved itself most effective?

The most effective element of Riders’ work is our single focus on delivering healthcare directly to the people who need it. We provide the missing link between the medical resources available in the 21st century, and previously isolated communities. We underpin the work of everyone working in and with rural communities where people are so vulnerable to hunger, poverty and easily-preventable disease.

Riders does not deal with state-of-the-art technology. The internal combustion engine has existed for more than one hundred years. Neither is Riders’ work ‘sexy’. But it is practical and it is vital. If the issue of transportation is not addressed, development cannot take place and millions more people will continue to die needlessly.

Number of clients in the last year?

Riders currently manages more than 1,200 vehicles for over 30 partner organisations.
In 2006, 289 delegates from 23 organisations also trained at Riders’ International Academy of Vehicle Management.

What is the potential demand?

“Riders for Health does a remarkable job at something that is relatively simple, relatively inexpensive but has the potential for spreading an effect all over the African continent.”
Nils Daulaire, CEO and President, Global Health Council.

Any organisation working in and with rural communities, or which requires reliable mobility to deliver its services, can benefit from Riders’ work. The TRM system is used for four-wheel vehicles, motorcycles, trucks, boats, water pumps, generators etc and can be more generally applied to mechanical technology of all kinds. It can work just as well for just one motorcycle for a remote mission hospital, ten ambulances or a ministry of health or the UN operating 1000 four-wheeled vehicles across an entire country.

Scaling up Strategy

Riders’ model was developed specifically to provide a replicable system that could be put into practice in all African countries, and to be adaptable to meet local conditions for use in other developing countries. Our immediate priority is to double our impact to reach another 10 million people, by building capacity in our existing programmes and replicating our model in new African countries.

Stage of the initiative:

1

Expansion plan:

To achieve the scale we envisage across Africa, we are shaping our existing initiatives as models for replication across the continent. Our focus here is to expand and strengthen the work already being undertaken, to ensure that we reach all the people in these countries who are in great need and where the Riders’ infrastructure is already in place.

We have also established a replication team to oversee the expansion of our model into new countries. In a similar approach to that which we have used in our existing programmes, we will communicate with UN agencies, NGOs both large and small, government ministries and commercial institutions, enabling these entities to learn about and adopt our model.

Riders plans to begin two new programmes in 2007. In Mozambique, we will work with the Ministry of Health to mobilize its public health workers, starting in Nampula Province. In Lesotho, we will work with partner agencies already at work in the country, to ensure that drugs and healthcare reach even the most isolated communities in the fight against HIV/AIDS and multi-drug resistant TB.

Origin of the Initiative

My husband and I were brought together by our passion for motorcycle racing, and set up our own marketing consultancy. Amongst others, we managed American racer Randy Mamola, and together we began raising money to help children in Africa. In 1988 we went to Somalia to visit one of the projects we had funded. We weren’t able to see the immunization day we were supposed to see, because the vehicle broke down. Instead, we could not help but focus on all the broken vehicles around us, some of them with only a few kilometres recorded. And when we saw a woman dying in childbirth, simply because there was no way of reaching a hospital, there seemed to be little choice but to come up with a solution. Not a solution just for that woman, or that country, but one that could be used anywhere. We came from the developed world where there is money, we understood engines, and we knew we could do it.

Sustainability
What are your two main challenges to finance the growth of your initiative

Our experiences in the development environment have taught us many lessons. Key among them is that African governments and small, in-country NGOs are desperate for transportation, but they rarely have funding for either the capital costs of vehicles or the running costs. It has also been difficult to draw the attention of development agencies and officials to the issue of transportation, and to convince them of the need for effective, accurately-costed vehicle management. Most focus on specific interventions, without taking into consideration exactly how they will be delivered.

To scale-up the initiative would require both capital investment to set up the necessary infrastructure in new countries (approximately $500,000 per program depending on the size of the country and the size and type of vehicle fleet to be managed). Funding for the running costs for the vehicles might also be needed until the in-country partner was in a position to take full responsibility for these.

How did you hear about this contest and what is your main incentive to participate?

Contacted directly by Ashoka. Our incentive is to see a change in the approach to development for people living in poverty and ill health. Entrepreneurism is the future for development, and a community that celebrates and fosters innovations in development is a necessary and valuable one.

The Story
Do you have an annual financial statement?

Yes, as a UK-registered charity we are legally obliged to submit our audited accounts and a financial report to the Charities Commission on an annual basis. External auditors review the financial statements from each country program and these are then consolidated in the UK.

Do you currently have an annual financial statement that tracks profit/loss?

Yes, our financial report records surplus/deficit.

Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.

The funding requirements are per program and are not cumulative from years one to five.