Healthcare Logistics in Africa

In 2004, ITDP began building on its success with its Access Africa program by taking larger steps toward reaching the heath care targets established by the United Nations to reduce poverty by 50% by 2015. It had become increasingly clear that better transportation was critical to the goals of the reducing maternal mortality by 75% by 2015, and halting the spread and reducing the incidence of HIV/AIDS, malaria, and other major diseases.

ITDP knew that without functioning vehicles, roads alone would do little. The UN alone spends $200 million every year on new vehicles. If just one year’s budget were spent on setting up proper maintenance facilities, perhaps $400 million could be saved over the following two years and approximately $130 million every year thereafter.

ITDP began its work by sending Jürgen Heyen-Perschon, the director of ITDP’s sister organization, ITDP Europe, to Ghana and Senegal to help develop a scalable project that would systematically deal with health care logistics needs.

When Jürgen visited the pilot communities, however, he found that a significant portion of the required ambulances, motorcycles, and bicycles stipulated by the national government were in disrepair or lacking entirely. In Ghana, for example, the average vehicle age of 7.7 years was resulting in higher fuel consumption and repair costs.  We set up pilot projects in local health districts in Ghana, Senegal, and South Africa to address mobility and communications needs in a way that could expand healthcare interventions to encompass broader areas.

Following interviews with various health care NGOs, Jürgen concluded the following:

• Vehicle breakdown was sometimes the result of having vehicles with specifications that weren’t appropriate for the rugged terrain.
• Spare parts and maintenance costs were frequently not budgeted or planned for.
• Many times, there were no personnel with the necessary skill responsible for maintaining or repairing the vehicles.
• There were insufficient funds to buy new vehicles to replace old vehicles.
• Telecommunications play a critical, frequently overlook role in improving the efficient use of a scarce vehicle fleet and improving the referral system.

ITDP set up pilot projects in each of the districts it studied to systematically address the mobility and communications needs in a way that would give us a rough idea of what it would take to bring such interventions to scale.  We distributed bicycles and communications equipment to nurses and health care workers in coordination with in-country health officials.

We increased the allocation of bicycles to local health points as a more cost effective approach than using more motorcycles with fewer people. (For every one motorcycle purchase, you can buy 30 bicycles.) The technical specification of the bike was modified also, using ITDP’s California Bike, a six-speed bicycle with wide tires to help in sandy or muddy conditions.  To strengthen supervisory capacity within the districts, radios and cell phones were deemed a better investment than simply adding more vehicles.

We delivered the bicycles and communications equipment to the pilot districts in November 2005, and fielded a team of experts to train local staff in maintenance.  ITDP has also been collecting data to develop a new, scalable framework that identifies the most effective combination of vehicles (four-wheel ambulances, motorcycles, or bikes) and communications equipment (radios or cell phones).  This framework takes into account factors that vary with each region, such as the type of terrain, the technical capacity of local staff, and budgetary resources.

The next step is to conduct an integrated pilot project that spans all levels in the district, and brings together transport, telecommunications and human resources.

For more information about this project, contact:

Aimée Gauthier