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.
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.
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.
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.