Sample Transport: reducing the time delay in detecting, diagnosing and monitoring HIV and TB.

Sample Transport: reducing the time delay in detecting, diagnosing and monitoring HIV and TB.

LesothoUnited Kingdom
Organization type: 
nonprofit/ngo/citizen sector
Project Stage:
Project Summary
Elevator Pitch

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

Riders’ Sample Transport model is an innovative motorcycle courier system reducing the time-delay in monitoring and diagnosing HIV/AIDS and TB.

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!

Riders for Health (Riders) is a social enterprise dedicated to achieving equitable health care access. 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. The Sample Transport (ST) model is a key part of this and was designed, at partner request, to address the bottleneck in primary-level laboratory service access. To do this, Riders recruits and trains specialist motorcycle couriers whose role is to collect diagnostic specimens from health centres and deliver them to the designated laboratory. Post-analysis, the results are returned to the health centre – which allows for expedited follow-up care. All vehicle fleets are managed in-line with Riders’ ‘zero-breakdown’ system and each ST courier is trained in vehicle maintenance and road safety. This process is supported by Riders’ own technicians who deliver outreach maintenance in accordance with an agreed service schedule.
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 ST programme aims to reduce the delay in monitoring and diagnosing HIV and TB by bringing reliability to the collection/delivery of samples and the return of results. Initially focused across Lesotho’s 155 health centres, programme development can be outlined as follows: 2007/8: At partner request, Riders allocate 30 motorcycles to the development of the first-ever ST model in Lesotho. Qacha’s Nek district is set-up as a pilot region. Jan/Aug 2009: Riders works in collaboration with the Ministry of Health to roll out the ST model nationwide. -Directly preceding each new district, Riders’ in-country team visit each health centre to develop service routes and prepare for project implementation. -District by district, Riders recruits local couriers with specific knowledge of the terrain. Each courier then completes two-weeks training in road safety and vehicle maintenance. -All couriers receive route-specific instruction and train in professional sample handling. Sept 2009: ST becomes a fully-operational nationwide programme. Regular outreach maintenance ensures the provision of reliable service. Present: All health centres across Lesotho now receive a weekly ST service. This strengthens public health services by ensuring that the country’s 2 million men, women and children have access to laboratory testing. By improving the turnaround time of test results, Riders is helping to reduce the number of patients defaulting on follow-up care/treatment regimes, build public trust in the health system and increase the demand for testing.

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.

Founding Story

Riders began when people working in the grand prix paddock began fundraising for children in developing countries. In the late 1980s, Barry and Andrea Coleman, and GP racer Randy Mamola, were invited to Africa to see the impact of this donation. Here, they noticed that vehicles intended for health care delivery had broken down, and that many life-saving services were at a standstill. Recognising the situation as unacceptable, Riders for Health was borne. In 2008, Riders’ partners in Lesotho voiced the need for a reliable system of sample transportation. Though the request lay outside core operations, Riders immediately allocated 30 bikes to programme development. The programme has seen overwhelming results - with our ST couriers collectively transporting over 2,000 samples and results each week, and many health centres reporting an increased demand for testing. At this point, we knew that ST was a sustainable solution with the potential to transform thousands of lives.
About You
Riders for Health
About You
First Name

Riders for Health

Last Name

Jennifer Parsons

About Your Organization
Organization Name

Riders for Health

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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How long have you been in operation?

Operating for 1‐5 years

Which of the following best describes the barrier(s) your innovation addresses? Choose up to two

Access, Equity.

Social Impact
Please describe the goal of your initiative; outline what you are trying to achieve

Riders’ vision if of a world in which no-one will die of an easily preventable or curable disease because barriers of distance, terrain or poverty stop them from being reached. Our ST model is a key part of a wider organisational strategy to achieve this change. Vehicle maintenance is not glamorous, but Riders persists in bringing this fundamental issue to the forefront of health care development. A confirmed health impact supports governments and the wider development community in understanding and prioritising transport management. This will help to ensure that every major global health initiative includes managed transportation as an integral part of its work - and of a country’s health system. An essential step towards achieving equitable health care access.

What has been the impact of your solution to date?

Building on success in Lesotho, the ST model has expanded into regions of Zambia and Zimbabwe – improving laboratory service access for an estimated 2.5 million people. Impact includes:

• Increased reliability of sample collection/results delivery: Health centres know when to expect results and can ensure timely follow-up care. All health facilities in Lesotho have a weekly ST service.
• Quicker turnaround of results: All regions involved with ST have seen a decrease in average turn-around time (sample collection/return of result) of up to 50%.
• Reduction in sample rejection: Professional handling means fewer specimens are spoiled in transit. 100% of health centres interviewed have reported a notable reduction in sample rejection.
• Improved health centre attendance and patient testing: This is due to increased trust in health services. In Zambia, health centres have seen a 114% increase in patient attendance and a 150% increase in samples/results being transported.

What is your projected impact over the next five years?

Riders’ five-year strategy is focused on scaling-up operational growth (in both existing and new country programmes) and thus enabling our partners to reach millions more people with the delivery of key health interventions in the poorest regions of Africa. In-line with these objectives, Riders has set the ambitious target of expanding our services to have improved health care access for 20 million people by 2015. Our ST programme is a key part of this. Over the next five years, we aim to:

• Expand on Riders’ existing ST programmes in Zambia and Zimbabwe.
• Build the ST mode into others existing country programmes, including Kenya and Nigeria.
• Build brand new partnerships and pilot the Sample Transport courier model in new territories - Malawi in particular.

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

1)Riders’ programmes are run by local people. At times, lack of technical capacity can be a barrier to the implementation/expansion of ST. To overcome this, Riders invests in local skills and trains all staff in safe driving and vehicle maintenance. Couriers are also given professional training in sample handling. Riders also offers cross-programme mentoring, which provides staff with the opportunity to learn from other programmes.

2)An efficient ST service can highlight broader health system weaknesses (e.g. poor lab staffing). To overcome this Riders collaborates with partners to select appropriate pilot districts, assess feasibility and expand our programme step-by-step. The use of pilot projects allows us to identify any potential pitfalls and to act on the lessons learnt.

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

We aim to expand ST into Kenya – an existing territory. This will involve the set-up of a small-scale pilot in three districts.

Identify three major tasks you will have to complete to reach your six-month milestone
Task 1

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

Task 2

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

Task 3

To build on existing infrastructure in Kisumu so that technical staff can deliver regular outreach maintenance to the fleet.

Now think bigger! Identify your 12-month impact milestone

To have 10 ST couriers operating across Kenya’s Nyanza province, providing a service with potential to support 850,000 people.

Identify three major tasks you will have to complete to reach your 12-month milestone
Task 1

The provision of a reliable and consistent ST service across three districts of Kenya’s Nyanza province.

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 robust M&E system.

Tell us about your partnerships

ST is a multi-stakeholder project that can only work as a partnership operation and Riders continues to work closely with partners in Lesotho, Zambia and Zimbabwe to develop an appropriate service that meets identified needs. Riders has learnt the importance of stakeholder involvement and the practicalities implicit when developing such a project. Communication is essential and all programme targets are developed as an integral part of partnership agreements. Such a constructive working relationship is pivotal to the overall success of the ST programme.

Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?

Riders’ work is focused on improving health care access for rural communities in sub-Saharan Africa. We work in eight countries, all of which are within the lowest 25% of the 2011 Human Development Index. Within this scope, the ST programme supports people living with HIV/AIDS, the early infant diagnosis of HIV and the expedited detection/treatment on TB. At present, the ST model operates across Lesotho and in regions of Zambia and Zimbabwe. Riders continues to target markets in existing and new country territories that will benefit from improved laboratory access at a primary level.

What type of operating environment and internal organizational factors make your innovation successful?

Every year, 1.8 million people die from HIV/AIDS, with 20% of deaths due to co-infection with TB. Riders believes that if we are to overcome such challenges, we must support health-focused organisations in strengthening their delivery platforms. The ST model is a prime example of this ethic. Throughout programme development, Riders listened to and learnt from those working on the ground. Driven by our belief in transport for development, we developed a bespoke solution that enabled us to better serve our partners and respond to their specific needs, whilst retaining focus on our core mission statement. Leveraging 20 years experience towards this new challenge, we have created a sustainable solution that expedites the detection, diagnosis and treatment of HIV/AIDS and TB.

Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list

Riders are continuously looking to improve the efficiency and quality of the service we offer so as to leverage a positive health impact. We often work with external consultants on a pro bono basis, who have supported us in areas of operations, fundraising and law.