A life-saving diagnosis: Sample Transport, reducing the time delay in monitoring and diagnosing HIV and TB.

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A life-saving diagnosis: Sample Transport, reducing the time delay in monitoring and diagnosing HIV and TB.

Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
$250,000 - $500,000
Project Summary
Elevator Pitch

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

Riders for Health’s vision is of a world in which no-one will die of easily preventable or curable diseases because barriers of distance, terrain or poverty stop them from being reached. Our mission is to strengthen health systems by addressing one of the most neglected, aspects of development for the health of Africa – transport and logistics. By 2015, we aim to have improved healthcare access for 20 million people.

Our Sample Transport (ST) programme is a practical innovation addressing a fundamental need in healthcare development – the transportation of diagnostic samples and test results. By ensuring the timely delivery of specimens to laboratories, Riders can dramatically reduce the delay in monitoring/diagnosing HIV and TB, improving health service access across rural Africa.

About Project

Problem: What problem is this project trying to address?

Laboratories are critical to the detection, timely diagnosis and treatment of communicable diseases like HIV and tuberculosis (TB). Yet in rural Africa these services are not easily accessible due to distance, road conditions and a lack of transportation. The result is that potentially hazardous specimens are often carried in improvised containers – at times a plastic bag – in non-specialist vehicles. This poses a serious health risk to those carrying the samples and to others using the same transport. It also means that specimens are not protected during the journey and are often spoiled in transit. The inherent time-delay leads to unacceptable patient waiting times. This not only impacts the health of individuals, but can also put entire communities at risk of infection.

Solution: What is the proposed solution? Please be specific!

No-one offers this service in the last mile. Our innovation, the ST programme, is a sustainable business model that improves access to primary-level laboratory services and strengthens rural health systems. A partnership operation, at Riders we believe that comprehensive fleet management goes beyond the remit of health agencies, and that these areas should be outsourced to a specialist partner. At present we are the only organisation taking such a ‘hands-on’ approach to health system strengthening. Such focused expertise has put Riders in the unique position to develop solutions in-line with stakeholder priorities. Driven by the same commitment to a positive health outcome as our partners, these shared objectives inspired us to evolve services and develop the ST model - a system that strengthens existing health infrastructures, eliminates wastage and builds in-country capacity. Closing a critical gap in the healthcare delivery chain, ST is a cost-effective and practical solution that has proven more appropriate for development than any private-sector service. Its recognised success is an effective demonstration of transportation in the healthcare field and encourages ministries, NGOs and the wider development community to prioritise transport management. The result of a public-private partnership, the ST model utilises grant funding to finance project set-up, but hands over financial responsibility to the respective partner. Such enterprise not only ensures programme sustainability but also opens up new opportunities for financing health system strengthening.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

The aim of the ST programme is to reduce the turnaround time of diagnostic samples and bring reliability to the collection/delivery of patient specimens and the return of their results. The model was first designed in response to the need identified in Lesotho and became a nationwide service (across all 155 health centres) in 2009. Three years later the Riders ST programme has extended into Zambia and Zimbabwe, employs 40 sample couriers, serves 255 health centres and 20 laboratories, improving access to primary-level laboratory services for a potential 3 million people. Project activities include: • The recruitment of motorcycle couriers followed by two weeks intensive training in safe driving, vehicle maintenance and professional sample handling. (Riders is also responsible for procuring appropriate motorcycles, protective clothing and specialised back-packs for transporting samples safely). • The regular collection of diagnostic specimens from health centres by specialist couriers. These are then transported in a safe, professional, consistent and controlled manner to the designated laboratory. • The prompt return of all results to the relevant clinic. This allows for expedited follow-up with individual patients. • The management of motorcycle fleets in-line with Riders’ core maintenance systems and ‘zero-breakdown’ policy. This includes the timetabled outreach maintenance of all motorcycles. By ensuring that vehicles are mobile at all times Riders offers reliable and predictable sample transport services. • The implementation of a robust monitoring and evaluation (M&E) framework.

Marketplace: Who else is addressing the problem outlined here? How does the proposed project differ from these approaches?

It is often not commercially viable for private-sector corporations, such as DHL, to operate sample referral systems that extend beyond a district/provincial level. Primary-level coping mechanisms have evolved to fill the inherent gap, but Riders remains unique in that we offer a bespoke solution to enable ‘last mile’ laboratory service access. Riders does not set-up its systems in parallel and it is our aim to compliment and strengthen existing health infrastructures. As a result, the ST model has been specifically designed to be cost-effective, eliminate waste, build in-country capacity and maximise stakeholder resources. As such it has shown itself to be more appropriate for development (particularly for government ministries) than any other service.
About You
Riders for Health
About You
First Name


Last Name


About Your Organization
Organization Name

Riders for Health

Organization Phone

+44 (0)1604 889570

Organization Address

The Drummonds, Spring Hill Office Park, Pitsford, Northampton. NN6 9AA

Organization Country
Country where this project is creating social impact
How long has your organization been operating?

More than 5 years

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What stage is your project in?

Operating for 1‐5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

The World Health Organisation currently estimates that 33.4 million people across the world are living with HIV/AIDS. Of these, two thirds of infections are located in sub-Saharan Africa. TB is cited as the leading cause of death in HIV-positive patients. One of the major challenges in managing the burden of diseases like HIV and TB is the detection, diagnosis and monitoring of the disease. The laboratory is pivotal to the provision of these services but distance, geography and a lack of transport means that they are not easily accessible.

Riders work in seven sub-Saharan countries, all of which are ranked within the lowest 25% of the 2010 Human Development Index. Currently focused across Lesotho and in regions of Zambia and Zimbabwe, the ST programme offers a non-discriminatory service that ensures the provision of primary-level laboratory services to a potential 3 million men, women and children. We work with communities isolated by barriers of distance, poverty and terrain – ensuring that they get the answers they need. Within this, there is particular focus on those living with HIV/AIDS, early infant diagnosis and the expedited detection and treatment of TB.

Share the story of the founder and what inspired the founder to start this project

Riders started in the motorcycle community when a group of people began fundraising for children in developing countries. During several trips to Africa in the late 1980s to see the impact of this donation, Barry and Andrea Coleman and GP racer Randy Mamola noticed that vehicles intended for healthcare delivery were unused, simply because they had broken down. Barry and Andrea Coleman became determined to find a solution to the problem that they now recognised as undermining the development of Africa. Riders began as an operational wing of a larger children’s charity and were registered as an independent organisation in 1996.

In 2008, Riders were working in partnership with the Elton John Aids Foundation (EJAF) and the Lesotho Ministry of Health (MoH) to mobilise 120 outreach health workers nationwide. However, a recent government drive to decentralise ARV drugs had also highlighted an unforeseen bottleneck in primary-level laboratory access. The Clinton Health Access Initiative (CHAI) soon approached Riders and asked if we could direct our services towards this issue. 26 of the initial 120 motorcycles were reallocated for this purpose and the ST programme was launched in November 2008 - a joint venture between Riders, CHAI, EJAF and the Lesotho MoH.

Social Impact
Please describe how your project has been successful and how that success is measured

Across Lesotho, Zambia and Zimbabwe an estimated 3 million people now have access to primary-level laboratory services. To measure the impact of our work, Riders track the sample data collected, conduct interviews with couriers, hold partner feedback sessions and community discussions. Each courier also completes a logsheet which monitors the use of their motorcycle. Headline impact includes:

• Increased regularity/reliability of sample collection and results delivery: Health centres know when to expect results and can ensure a timely diagnosis. In Lesotho, 100% of health facilities now have a weekly ST service.
• Quicker turnaround of results: All countries involved with ST have seen a decrease in average turn-around times (from sample collection to the return of results) of up to 50%.
• Reduction in sample rejection: Improved sample handling means fewer specimens are rejected by the laboratory and patients are not recalled for repeat testing. In Lesotho, Zambia and Zimbabwe 100% of interviewed health centres reported a notable reduction in sample rejection.
• Improved health centre attendance and patient testing: This is due to increased trust in the healthcare system. In Zambia, health centres have seen a 114.2% increase in patient attendance and a 150% increase in samples/results being transported.

How many people have been impacted by your project?

More than 10,000

How many people could be impacted by your project in the next three years?

More than 10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

It is our aim to replicate the ST service and expand into Malawi, a new territory for Riders. This will involve the set-up of a pilot project with 16 bikes in four districts.

Task 1

To complete a baseline study in each of the pilot districts.

Task 2

To procure the required motorcycles, recruit and train couriers in safe driving, basic vehicle maintenance and professional sample handling.

Task 3

To recruit and train technical staff in comprehensive vehicle maintenance and fleet management so that they can deliver regular outreach maintenance to our vehicle fleet.

Identify your 12-month impact milestone

To have 16 operational ST couriers serving four districts across the Northern, Central and Southern regions of Malawi. To have implemented a robust M&E system.

Task 1

The provision of a reliable and consistent ST service across four districts of Malawi.

Task 2

The regular delivery of outreach maintenance (once every three months) to all courier vehicles by Riders’ trained technicians.

Task 3

The continued review and assessment of programme development through our M&E framework.

How will your project evolve over the next three years?

Over the next three years, Riders hope to have completed a nationwide baseline study in Malawi and to have rolled-out a full ST service across the country’s 540 health centres. We are also looking to build on, and expand our existing ST programmes in Kenya, Zambia and Zimbabwe, working closely with our partners to scale-up our activities. Finally, we would hope to have added new partnerships to the Riders portfolio and to have built on our existing infrastructure by introducing pilot ST programmes into both Kenya and Nigeria.

What barriers might hinder the success of your project and how do you plan to overcome them?

1)Each of Riders’ programmes are run and managed by local people. At times, lack of technical capacity (driving skills, fleet management expertise etc.) can be a barrier to the implementation and expansion of the ST model. To overcome this, Riders invest heavily in local skills and train all staff members in safe driving, vehicle maintenance, journey planning and fleet management. Couriers are also given professional training in the handling of potentially hazardous materials. We also offer outreach training and cross-programme mentoring, which provides our staff with the opportunity to visit and learn from other Riders' programmes.

2)An efficient ST system can highlight weaknesses within the broader healthcare system that go beyond the role and remit of Riders (e.g. poor lab staffing, lack of resources and equipment). To overcome these barriers Riders works closely with our partners to select appropriate pilot districts, assess feasibility and expand our programme step-by-step. The introduction of pilot projects allows us to identify any potential pitfalls and to act on the lessons learnt. It also gives health centres time to alert the patients and plan for the introduction of the ST service.

Tell us about your partnerships

Riders ST program illustrates a successful public-private partnership model. As a multi-stakeholder project, ST can only work as a partnership operation and Riders continue to work closely with the relevant ministry and our other health-focused partners in Lesotho, Zambia and Zimbabwe to develop an appropriate service that remains sympathetic to local context.

Throughout the expansion of our ST model, Riders have learnt the importance of stakeholder involvement and the practicalities implicit when developing such a project. Communication and transparency is essential throughout every step of development and all programme targets are developed as an integral part of partnership agreements. These are documented in the final Memorandum of Understanding (MoU) between Riders and our partners in Lesotho, Zambia and Zimbabwe. Such a solid foundation and constructive working relationship is pivotal to the overall management, implementation and success of the ST programme.

Key partners include:
• The Elton John Aids Foundation (EJAF) - Lesotho
• The Clinton Health Access Initiative (CHAI) – Lesotho, Zimbabwe, Malawi
• The International Union Against Tuberculosis and Lung Disease (The Union) – Zimbabwe
• The Ministry of Health and Social Welfare - Lesotho
• The Ministry of Health and Child Welfare - Zimbabwe
• The Ministry of Health – Zambia
• The Ministry of Health – Malawi

Explain your selections

Funding for the ST programme can be divided into two main areas: capital set-up costs (the purchase of motorcycles, backpacks, protective gear and training) and ongoing running costs (fuel, parts and outreach maintenance). As the main implementer of the programme infrastructure, Riders secure grant funding for the capital set-up costs, but the programme is designed for the ongoing running costs to become the responsibility of the MoH or other operational partners, to ensure sustainability. Making allowances for local differences, it costs approximately $900 per month to keep a sample courier on the road – with an average journey to/from the laboratory costing £5.

Once the programme is established our partners will take on the running costs of the sample couriers through payment of a non-profit fee based on a precise understanding of how much money vehicles use in terms of management, distance, fuel and parts. By calculating the true running cost of any vehicle in any environment, Riders can regulate the normally unpredictable expense of vehicle maintenance and our partners can accurately budget for all future vehicle expenditure.

How do you plan to strengthen your project in the next three years?

Riders have set the ambitious target of expanding all our services so that we can improve healthcare access for further 10 million people by 2015. The expansion and development of the ST programme is key to achieving this objective, and as the project gains momentum it is our aim to draw in additional health-focused partners that will support programme growth, maximise expertise and advocate the issue of transport for development.

As with any Riders model, the ST programme is supported by a robust M&E framework, and this allows for the constant reflection, assessment and evaluation of project development. We will continue to work closely with our partners throughout this process, and will work together to refine our service model, overcome setbacks and ensure the provision of a professional and efficient ST system. To support this process Riders will continue to invest in staff training and will work closely with our partners in order to support the handover of ongoing running-costs, introducing our service fee in-line with stakeholder capacity – making the transition as smooth as possible.

Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.


Limited diagnosis/detection of diseases


Limited human capital (trained physicians, nurses, etc.)


Lack of physical access to care/lack of facilities

Please describe how your innovation specifically tackles the barriers listed above.

All countries benefitting from the ST programme have seen a decrease in the average turn-around time of test results of <50%. Such service reliability builds trust in local services, and this can increase health-seeking behaviour and diagnosis demand (in the first year of operations, health centres in Zambia saw a 150% rise in the number of samples transported). Thanks to ST, health centre staff no longer take ‘time out’ to deliver specimens and this maximises human capital, leaving health centre staff free to focus on patient care. Strengthening health systems across Africa, the ST system improves access to primary-level laboratory services for those once isolated by distance, poverty and terrain.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.



Grown geographic reach: Multi-country


Influenced other organizations and institutions through the spread of best practices

Please describe which of your growth activities are current or planned for the immediate future.

We are currently in discussion with the Malawi MoH and will sign a Memorandum of Understanding in the coming months. As part of our cross-programme mentoring scheme our Programme Director in Malawi, Alexander Bofu, has recently visited Riders projects in The Gambia, Zambia and Zimbabwe. This has provided him with a crucial insight into established ST programmes and of our service models as a whole. He has also attended training at the UK office, and we will continue to support him both remotely, and in-country, as project implementation begins.

The baseline study for Malawi is currently planned for the end of September. We are also in discussion with other health-focused partners in Kenya, Zimbabwe and Nigeria, and hope to have additional ST contracts in place by the end of 2012.

Do you collaborate with any of the following: (Check all that apply)


If yes, how have these collaborations helped your innovation to succeed?

The foundation of the ST model is built on collaboration, with the programme itself being a direct response to the needs identified by our partners. Here, Riders fast became the driving force of project development and worked hard to maximise stakeholder involvement, applying a breadth of expertise to the challenge of sample transport. We learnt from those around us and worked closely with all named parties to ensure the development of a practical and sustainable solution that seamlessly integrates into existing health systems – effecting change on the ground and at policy level.