3 December 2012

Africa: In Our Fight Against HIV/Aids, Transportation Can No Longer Be an After Thought

Photo: Judith Basutama/IRIN
Burundi returnees from Tanzania alighting from the trucks that brought them back to their country.

"As we surge towards an AIDS-free generation, we need to realistically face the challenges. Resting on our laurels is insufficient."

The 2012 International AIDS conference touted progress in combating HIV/AIDS and creating an "AIDS-free generation". Through programs like the President's Emergency Plan for AIDS Relief, billions have been spent on prevention education, early diagnosis, treatment protocols and medicines. Pioneering partnerships galvanized the global community, and statistics and compelling success stories abound.

As we surge towards an AIDS-free generation, we need to realistically face the challenges. Resting on our laurels is insufficient. We need to move beyond rhetoric and guarantee results that reach hundreds of millions more people-- effectively and sustainably. To conquer this disease, our efforts must be universal - we have to reach every child, woman and man.

In a recent Skoll World Forum op-ed, the managing director of the World Bank, Caroline Anstey, rightly pointed out that "In the 20th century, economic growth was driven by the ability to transport goods and people efficiently and economically - with automobiles, planes and ships. In the 21st century, it will be the ability to produce, capture, communicate and analyze information to drive new forms of growth and social development."

Yet, what is considered "problem solved" in a few countries is the biggest barrier in much of the world - especially in Africa. The fact remains that physical access is fundamental, not just to economic development, but to the long-term prevention and treatment of HIV/AIDS. Distance and terrain must be tackled and conquered if medicines, services and people are to be physically connected.

The latest drugs at the cheapest prices, even when in the hands of a knowledgeable health workforce, are of no value if patients can't be reached reliably. What is needed is investment in physical infrastructure that is practical, cost-effective and sustainable. Ambulances, trucks, motorcycles and other health vehicles must always be in operable conditions.

This is non-negotiable when you are in the business of saving lives.

Yet, current practice is reactive at best. The results? Delayed anti-retroviral (ARV) medicines, pregnant women who can't reach health facilities during emergencies, and a break down of the health system's effectiveness.

Riders for Health (Riders) was founded to address this challenge. Riders focuses on maintenance to maximize productivity and reduce downtime while preserving the transport assets. This might sound too uncomplicated and practical to be a missing solution to the AIDS problem, but it works!

Today, Riders manages health transport for organizations as varied as community-based organizations to ministries of health. Operating nationally and regionally in seven African countries, Riders helps health care reach over 12 million people.

Riders' expertise helps partners select appropriate vehicles for usage and terrain, practice preventive vehicle maintenance, train drivers in road safety, deliver outreach maintenance to remote locations and to budget and manage transport costs.

The lifespan of vehicles can be increased by up to 300%. Health workers mobilized by Riders reach four times more people than they did before, and spend more time in their communities.

Once the fundamentals of reliable transport are in place, it helps create a range of solutions. For example, where Riders for Health has used motorcycles in a courier service for patient diagnostic samples, testing times were reduced from weeks or months, to just days. Faster diagnosis can lead to quicker treatment. But most importantly, wider trust in the health system can increase. All impossible - without reliable transport.

Finally, with limited resources, accurate budgeting is important for long-term sustainability. Unexpected repairs may divert funding from fuel, decreasing availability of the vehicle, or from health care service delivery activities. What is the point of having ARVs in the warehouse but no fuel to get it to the patients in time? Put simply, vehicle management including logistics is not an optional extra for health interventions: it must be faced and integrated with the total cost of any intervention. But it must be done efficiently, locally and with very high standards.

In our fight against HIV/AIDS, appropriate and reliable transportation can no longer be an after thought - it must be a top priority for any health agenda that desires an AIDS-free generation.

Dr. Lakshmi Karan is Global Strategy Director of Riders for Health.

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