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Twa’ Luumba

Tuesday, March 19th, 2013

Dr. Kala Mehta, author of this post, is the lead research consultant working on the Riders for Health evaluation. Using data collected by the team based in Zambia, Kala conducts numerous analyses to measure the impact and effectiveness of the Riders for Health model. To learn more about the research, visit our website.

Twa’ Luumba.

Touching down in Livingstone, Zambia was at once a thrilling and exciting experience for me. As a lifelong researcher devoted to public health, I have always dreamed of working on health systems strengthening.  The team at the Stanford Global Supply Chain Forum has given me that unique opportunity.

Livingstone General Hospital.

Livingstone General Hospital. Davis Albohm

Our group is conducting a 2.5 year field trial of a health transport intervention in Southern Zambia. The premise is that if motorcycles and vehicles are newer and maintained, health workers will be able to do their work more efficiently and they will be able to serve more people. Perhaps this seems only logical, but pinning down the link between strengthening the health system and actual outcomes in health can be considered ‘the holy grail’ of public health. It is very hard to prove that building health infrastructure actually makes a difference in the health of the population served. Without that proof, there is no reason for big funders like the Bill & Melinda Gates Foundation to put their time, money and effort into this work. On the other hand, it will be a game changer for public health if this trial proves that a better infrastructure leads to better health.

In September, 2012, I spent eight days with Davis Albohm and George Muwowo, our team on the ground in Zambia. We went to several district health and medical offices, visited health workers and saw Riders for Health motorcycles and vehicles in action. I had the occasion to round at the hospital, where the inpatient population is virtually all HIV+ and babies die regularly of HIV-related complications. The visit in general helped me to see the critical role of health transport in the context of the supply chain.  For example, I witnessed how it affects emergency services, mobile health clinics, the cold chain for vaccine delivery, and daily health outreach to villages with no local health services. But one experience stood out for me above all others.

Village, Kazungula, Zambia.

Kazungula district village, Zambia. Davis Albohm

We stopped at a village alongside one of the few tarmac roads. There were several thatched roof houses, each with its own cooking fire, one per family. A woman with a child strapped to her back approached. I smiled and said “Twa’ Luumba”. The only words I knew in her language. She countered with a wide full toothed smile, universal for acceptance. She showed me to her home, the inside about 10 feet in diameter. Her whole family, and her baby slept together in this home. I was curious about her health, and that of her baby—who at the time had a mild persistent cough.  I asked her about her family, how she lives, and lastly, where she received health care. She said that she took her baby for shots at the nearby clinic. It was in our sample, and it was about 7 kilometers (approx. 4 ½ miles) away. She said she would go there walking. I asked her if health workers ever came to her village, she said ‘no’.  Though there were probably a hundred more questions to ask, time was short and we had to leave. The woman, whose name I still don’t know, was still smiling and waving. I said ‘Twa Lumbaa’ again through the open car window. I realized then, that if health systems strengthening and the Riders’ model works, it would reach… her.

Ambitious Measles Campaign Targets Zambia’s Youth

Wednesday, February 27th, 2013

Davis Albohm is a project manager for Stanford University’s Global Supply Chain Management Forum. He spends significant time in Zambia managing the logistics of the Riders for Health impact evaluation alongside his partner, George Muwowo. For more information on our research in Zambia, visit our website.

On a recent trip to Zambia, I witnessed the launch of the nation’s long-anticipated measles vaccination campaign. The goal for the week-long exercise was ambitious – 95 to 100 percent coverage of all children between 6 months and 15 years old – an estimated 6.5 million to be immunized. Here’s what I witnessed on the ground:

A health worker prepares a measles immunization inside a rural school, Itezhi-Tezhi.

As part of a fortuitously timed routine work trip, my partner George Muwowo and I set out from our Livingstone, Zambia office for the most remote district in our study area, Itezhi-Tezhi. Located more than 400 km away from Livingstone, Itezhi-Tezhi lies in the northwest corner of the province, its population living in small villages among the boundless floodplains.

When we arrived, I expected to witness significant challenges for the organizers, especially in a rural setting like Itezhi-Tezhi where the terrain is unforgiving and distances – even between neighboring villages – are vast.

However, we saw first-hand that local health officials were up to the challenge. Uniformed health workers and community volunteers were stationed at schools and health centers methodically moving children from one station to the next, beginning with paperwork and ending with vaccinations. Because of the district’s sparse population, lines appeared to be short.

Children receiving measles immunizations, Itezhi-Tezhi.

But all reports noted that turnout was extremely high. Throughout Itezhi-Tezhi and other districts we visited later in the week, there was no evidence of stock outs or delayed immunization deliveries. Children who had the means to travel to an immunization site were treated. Beyond measles, many children also received Vitamin A supplements and polio immunizations.

We spoke with several health workers who cited that a well-executed vaccine distribution plan, advance staff training and strong external support from organizations like UNICEF were critical to the efficiency of the campaign.

Children waiting for measles immunizations outside a school, Itezhi-Tezhi.

But, successful planning and logistics are just part of the success story. Comprehensive social mobilization efforts also appeared to play a key role. I witnessed a widely coordinated media outreach effort which seemed to penetrate much of Zambia. Daily advertisements in the two major national newspapers were published for weeks in advance. The national television broadcaster ZNBC ran PSAs every hour. Billboards were placed all over towns and posters were attached to the walls of every health center and school we visited. People we met reported strong awareness of the campaign, and had enough notice to plan a trip to the nearest immunization site.

While official numbers have not been tallied, the government reports success.  As part of our research in Zambia, our team collected immunization data from Environmental Health Technologists (EHTs), the cadre of health workers partly responsible for managing campaign logistics.


Welcome to Zambia

Saturday, December 8th, 2012

Dear Reader,

Welcome to Zambia. This new blog takes you straight to the ground for first-hand storytelling of the adventures, challenges and unexpected surprises that are part of the GSB’s evaluation of Riders for Health’s work in Zambia.

Health workers participating in motorcycle training during Riders for Health’s launch in Southern Province.

The GSB has 9 Zambian staff working, living and collecting data in the country’s Southern Province, a region the size of Indiana that 1.5 million men, women, and children call home. Conditions are extreme. Rain turn valleys into lakes, roads into rivers, and paralyze movement and transport for half of the year. Summer heat tops 110 degrees some days.

Through photos, videos and first-hand accounts, you will journey alongside our team as they travel by motorcycle to remote health centers, as they meet community health workers, collect data and survey the availability and condition of health-related vehicles and motorcycles.

Join Samson Muchumba for your first ride through Choma district by reading the post below.

But first, here’s a little background about our partner and the study:

A health worker administers measles immunizations in rural Zambia.

Riders for Health is a nonprofit organization focused on providing reliable and cost-efficient transportation solutions for health workers who are reaching out to rural communities in sub-Saharan Africa. Riders has developed a model where they manage vehicles and motorcycles with planned preventative maintenance, fuel, repair and driver training. In 2008, The Bill & Melinda Gates Foundation tasked Stanford University with evaluating the effectiveness and efficiency of contracting out vehicle fleet management as an approach to strengthening the performance of health delivery organizations. The Stanford data collection team is working in 8 districts in Zambia’s Southern Province. Every week, Stanford data collection officers interview health workers, collect health data and assess motorcycles and vehicles at more than 120 health centers. To learn more about the evaluation, visit our website.

-Davis Albohm, Stanford Project Manager