Riders for Health as a radically incremental innovation in health care delivery

by Anjali Sastry on October 16, 2009

We all agree that Riders for Health are pretty cool–Ducati are sponsors, and the pictures and videos on their website make us wish we could hang out with them.

riders in Kenya

But Riders also offers us a model for global health delivery worth exploring in detail. The organization is successful in their focused approach: they deliver motorcycle transportation for health workers to reach communities and patients in settings where access is crucial (here’s some evidence on the link between health and transportation). Recently, the Riders for Health model expanded to include their owning of the key assets–the motorcycles themselves–instead of only supplying their fuel and maintenance. They have also expanded to managing larger fleets (see the Gambia Transportation Asset Management program and a 2007 presentation of the precursor program in the Gambia in a mini case and video). Riders have also built a training facility to teach people how to manage and keep up vehicles for health service delivery. And an innovation in the motorcycle sidecar now enables some patients to be transported, as the last video shows. By the way here: bestessaywritingservice.co.uk you may find interesting educational posts too.

Riders delivers mobility at prices well below what local programs, NGOs, and Ministries of Health pay for their own transportation (see this 2005 Due Diligence Study of Riders’ Operations). So, we wondered, why do they run on a breakeven basis? Why not charge a little more, and become financially sustainable, while still saving their clients much money? What do you see as the issues to consider here?

Reflecting on the Riders for Health model, we asked: how is it revolutionary? Well, its innovation lies in the narrow focus: there are many things Riders does not do, and what it does do–from what we can tell–it does well. It also is innovative in choosing to use simple, rugged, standardized, easy-to-maintain motorcycles, and not Land Rovers or other vehicles that may carry more supplies and people but which may also not end up in use in the settings where Riders motorcycles now operate. So, relying on standard, low-tech motorcycles is incremental in the sense that such vehicles were already in use in the settings where Riders works; but it’s radical because few others would consider a motorcycle to be the right choice for addressing barriers to global health delivery, although eRanger has hit upon a similar idea. eRanger invested in the vehicle itself with “versatile and robust vehicle design to enable access over the toughest terrain to deliver its varied cargo safely and in one piece, ready to go into action quickly and easily.” A May 2009 Guardian article explored its use in reducing maternal deaths in Uganda. By the way, there are even bicycle ambulances  in Nepal and Namibia ; we uncovered a growing set of case studies of mobility on health that document the effects of a range of approaches. (And if you are looking to assess a rural setting in which you suspect mobility for health is needed, a good starting point is this how-to guide: A Methodology for Rapid Assessment of Rural Transport Services.)

Rider’s operational structure relies, unsurprisingly, on a hub-and-spoke model. Recently, some healthcare experts have been asking if the entire model of care in resource-limited settings should adopt such a structure: see my earlier blog post about such an alternative to doctor-centric care delivery models.

But in some ways what I consider most innovative about the Riders for Health model is their commitment to preventative maintenance. Pro-active, scheduled maintenance (made possible only by well-developed processes and routines, high availability of supplies and parts, and effective record-keeping in the form of service logs for each vehicle) combined with frequent, simple checks to catch problems before they worsen means that Riders for Health users can count on their vehicles to be available when they need them. Now, what’s the lesson in this all for global health delivery, writ large?

{ 1 comment… read it below or add one }

Howell Tumlin October 16, 2009 at 4:24 pm

You got it. The “radical” proposition of Riders, however, is not the use of motorcycles as tools for healthcare delivery, cool and interesting as that is. The far more revolutionary postulation that is at the heart of Riders program is that preventive maintenance programs, that are essential for realizing the full benefit of any investment in transportation, can be effectively introduced to rural Africa. For many years, I worked as a fundraiser for a foundation that supplied vehicles to support healthcare institutions and community health programs throughout the developing world. It was axiomatic in those days that vehicles did not last very long in rural Africa settings because of the conditions in which they operated. We thought nothing of supplying rural hospitals with a new vehicle every couple of years. Millions of dollars were spend to replace vehicles that broke down prematurely and were abandoned to rust behind hospital compounds. What Riders has introduced to global health is the radical notion that the problem is not the African environment or the engineering of the vehicles. The primary cause of unreliable transportation for healthcare in Africa is too little attention to properly maintaining the vehicles. Toyota Landcruisers are not too technologically sophisticated for rural Africa. They are actually well engineered. When they fail, it is most often, as Riders co-found Barry Coleman is want to say, because the Toyota Owners’ Manual which is delivered with every vehicle is never read, muchless taken seriously. Riders has challenged the notion that vehicle maintenance programs cannot be effectively introduced to Africa and managed by African teams. The use of motorcycles to deliver healthcare, which have proven to be able to be safe, reliable and effective transportation capable of reaching virtually any place on earth, is only a radical notion when it is coupled with Riders commitment to make sure that premature vehicle failure is not only not inevitable, it is unacceptable.

Howell

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