From August 25 to September 12, 2025, R4H conducted a significant training across five districts in Malawi: Nsanje, Ntcheu, Nkhatabay, Mzimba South, and Machinga. A total of 354 healthcare workers were trained in Optimized Sample Transport (OST).  The system is designed to enhance the efficiency of medical sample transport using a pull system and USSD technology.  This innovative approach allows healthcare facilities to report available samples efficiently, enabling R4H route optimization officers to determine facility visit route schedules, that improve transport efficiency and reduce costs.

The training used a group discussion approach at individual facilities, with R4H facilitators guiding healthcare workers through the process of USSD reporting for various sample types. The training had three main objectives: to introduce OST to healthcare workers, to train them on sample notification and transport requests, and to teach practical steps for USSD reporting.

From October 2023 to September 2024, OST had been implemented in Phalombe, Rumphi, Salima, Lilongwe, and Mzimba North. The program was then scaled up to include Mangochi, Blantyre, Zomba, Chikwawa, Chiradzulu, and Mulanje, and later to 5 newly scaled-up districts, Machinga, Nsanje, Mzimba South, Nkhatabay, and Ntcheu, in quarter 4 2024-25 FY, bringing the total to 16 districts under the OST program.

OST operates as a demand-driven system where healthcare workers use specific codes to report sample volumes.  These reports are sent to the R4H central office, where an OST team creates courier routes for the following day.  This system not only increases efficiency, but also results in significant cost savings, i.e., Empty trips, reduced TAT, samples rejections, wear and tear, among others.   The training targeted key personnel at each facility, including the facility in charge, HIV Diagnostic Assistant (HDA), and a TB officer, to ensure a comprehensive understanding and implementation of the OST system.

 

In August 2025, Angellina Mwase, the R4H Sample Transport Manager for Quality Assurance, and Alice Mbozi, the Sample Transport Coordinator for the Central Region, conducted a spot check activity at St Gabriel Hospital in Lilongwe rural. This exercise highlighted the dedication of R4H’s sample transport couriers in enhancing medical sample transportation. In Mchinji District, these couriers play an important role in ensuring the timely delivery of medical samples, which is very important for effective HIV diagnosis and treatment in the region.

The efficient transportation of samples in all R4H implementing districts significantly reduces turnaround time (TAT), allowing for faster clinical decisions and improved patient outcomes. Lufina Hamison, an HIV Diagnostics Assistant at ST Gabriel Hospital, noted that R4H’s medical sample transportation system is instrumental in minimizing delays. This system ensures that samples reach their destinations on time, facilitating quicker diagnostic processes.

In Mchinji, the allocated couriers, Geoffrey Mphepo and Madalitso Mtonda, also contribute significantly by transporting quality controls (QCs) for recency testing and delivering reports to and from the District Hospital. This effort further strengthens the diagnostic process, ensuring accuracy and reliability. The collaborative work of these couriers and healthcare professionals is enhancing healthcare delivery and improving medication effectiveness across the district.

In the northern region of Malawi, the R4H medical sample transport program has improved healthcare delivery, particularly in remote areas like Chitipa. Using dedicated motorcycle couriers who are the backbone of this project, this initiative has significantly improved the efficiency of transporting critical medical samples, including HIV Viral Load and Tuberculosis (TB) sputum samples, from health centers like Nthalire, located 125 km from Chitipa District Hospital, and others like Kameme, Kapenda, Chambo, Misuku, and Wenya, just to mention a few.

Despite challenging terrains, R4H couriers showcase untiring commitment, ensuring timely collection and delivery of samples to the hub and molecular laboratories and transporting the results back to the health centers. This seamless coordination not only facilitates the swift return of test results but also empowers healthcare workers to administer appropriate treatment to ART clients and TB patients on time. In June 2025, during an interaction with healthcare workers during the joint spot check and Data Quality Assessment exercise championed by R4H programs and Monitoring, Evaluation, Accountability and Learning (MEAL) team, Besten Banda, laboratory technician at Nthalire Health Center, commented, “The couriers are very important in connecting our laboratory to the mother laboratory, enhancing our capacity to provide quality healthcare.”

Luke Mbale, an ART Clerk at Chambo Health Center, added, “The sample transport program ensures timely reception of results, improving healthcare for ART clients.”

Beyond sample transportation, these couriers also assist in urgent deliveries of reports and other hospital necessities like reagents, further complementing their role as links in the healthcare system. This is how innovative the sample transport program can enhance healthcare access and outcomes in underserved communities, making a compelling case for continued partnership with implementing partners and support from stakeholders and donors.

R4H continues to implement its Medical Sample and Result Transport Program across all 29 districts of Malawi. From 8th to 10th April 2025, Angellina Mwase, Programs Manager for Quality Assurance, led check-in meetings in Kasungu, Nkhotakota, and Dedza District Hospital Offices (DHOs). These meetings aimed to gather constructive feedback from District Medical Officers and laboratory technicians, who are the key contacts for R4H couriers at district hospitals.

During the discussions, Mphatso Mgungu, the Deputy Laboratory Manager and Health Surveillance Assistant (HSA) for Dedza DHO, expressed his appreciation for R4H’s efficiency. He highlighted that the program typically ensures that samples are transported from health facilities within 24 to 48 hours, a timeframe that significantly enhances the quality of patient care. “There are no challenges with couriers, nor have we reported any problems in terms of specimen and result handling,” Mgungu noted. He further emphasized the invaluable role of the couriers, stating that they assist in transporting essential items when immediate needs arise at health facilities or the DHO. For instance, well-packaged test- kits and critical reports ensuring that healthcare providers on both ends have the necessary resources.

However, Mgungu raised a concern regarding delays in transporting samples due to national fuel scarcity. He noted that this issue could potentially hinder the timely delivery of samples and results, which is crucial for effective patient management.

At Kasungu DHO, Felistus Somanje, the District Medical Officer (DMO), added on the opinions raised by her Dedza counterpart. She urged R4H to consider scaling up their reach to other health facilities in Kaungu that are currently not benefiting from the sample and result transport services. “There are several facilities in our district that would greatly benefit from this program,” Somanje stated. Expanding R4H’s services would not only improve our operational efficiency but also enhance patient outcomes across the board.

The meetings concluded with a commitment from R4H to explore ways to address the concerns raised including the expansion opportunities, ensuring that all healthcare facilities in Malawi can access timely and efficient transport of medical samples and results.

In April 2025, R4H conducted a transformative training program for its HR, Finance, and ICT staff, focusing on the Employee Self-Service (ESS) and Digitized Timesheet Systems. The training was for two days, 23rd and 24th April 2025, and it took place at the R4H Head Office in Lilongwe. The training focused on Sage VIP Premier ESS, learning about employee interfaces, leave management, and payroll processes. Facilitators Tanangachi Khonje, Payroll & HR Systems Consultant from Infosys, and Lonely Chisale, IT Assistant from R4H, led the sessions.

The training sessions were a success; participants were actively engaged and showcased their willingness to learn.

Tanangachi Khonje, Payroll & HR Systems Consultant from InfoSys, takes the participants through Sage Premier ESS and Payroll Module

Training Outcomes

1. Participants gained a thorough understanding of ESS and the Digitized Timesheets System
2. Participants are now capable of effectively managing system workflows and user administration modules within the ESS.

 Successes

1. The training sessions were marked by high levels of participant engagement, reflecting strong interest and active involvement throughout the program.
2. Successfully equipped participants with a comprehensive understanding of the ESS and Digitized Timesheets System.
3. Empowered participants to proficiently manage system workflows and user administration modules within the ESS.

 

 

In the first quarter of 2025, the uncertainty as the U.S. Government’s aid freeze cast a shadow over the R4H program. For two long weeks, the organization, including the Sample Transport couriers, faced a stop-work order, affecting the transportation of medical samples and results.

 Medical samples and results were not being transported.” I was receiving calls from healthcare workers to report to health facilities for sample collection, but I could not do so at that time due to the stop work order”, reported Matilda Banda, R4H Sample Transport Courier, Lilongwe district. The silence was worrisome, and the weight of responsibility felt heavier than ever with the uncertainty.

But then, in the week of 17th February, we were back on the road and it felt like a breath of fresh air. I remember the moment I received the communication from the head office through the Programs Manager, Angellina Mwase. “I called the healthcare workers from the health facilities I reach to inquire about the samples which were to be prioritized and sent to the molecular and hub laboratories for urgent testing” added Maltida.

Commenting on the impact of the executive stop work order in healthcare delivery, Francis Mdzingah- Health Surveillance Assistant (HSA) at Chiwamba Health Center in Lilongwe said “R4H couriers are known for their reliability; however, the stop work order disrupted operations in their implementing health facilities. Clients rely on timely results to manage their health based on viral load outcomes. Unfortunately, during this period, the delay in sample transportation posed a significant challenge, impacting the ability to provide timely health advice”.

“My heart was filled with joy as I loaded the first batch of HIV viral load and TB sputum samples into my courier bag. I was reminded that each sample represents a life, a story, and the hope for better health,” Matilda concluded.

Together with the Ministry of Health (MoH), and other implementing partners, R4H continues to transport medical samples and results in all 29 districts of Malawi,currently reaching 810 health facilities.

In the quarter October to December 2024, the R4H programs and Monitoring, Evaluation, and Learning (MEAL) teams conducted visits to 80 health centers across three regions of Malawi: the Southern, Central, and Northern regions. Specifically, they visited health centres in Chikwawa, Zomba, and Blantyre in the Southern Region; Mchinji and Ntchisi in the Central Region; and Rumphi and Karonga in the Northern Region. The primary objective of these visits was to review the sample transport program and engage with key stakeholders. These engagements were aimed at gathering feedback on the program’s successes, identifying areas that are functioning well, and highlighting aspects that require improvement. One of the motivating factors during these visits was hearing positive feedback from partners, including HIV Diagnostic Assistants (HDAs) and Health Surveillance Assistants (HSAs), who are deployed under various partners such as the Ministry of Health (MoH) and Right to Care. These partners work closely with the R4H sample transport couriers at health centers, ensuring that samples are collected and transported on time for diagnosis.

A key testimonial shared during the period from October to December 2024 came from Peter Mpinga, HDA under Right to Care at Malomo health centre. He described a situation that occurred within October to November 2024 in which a client who had difficulty in walking needed to have a viral load sample drawn but could not make it to the health center. In response, the HDAs traveled to Chakulanjala, a village 10 kilometers from Malomo Health Centre, to draw the sample. Fortunately, R4H courier Brino Katchengera arrived at Malomo Health Center to collect the samples but the HDAs were not available. Upon contacting them, he was informed that they were at Chakulanjala, drawing the sample from the client. Brino followed the HDAs to Chakulanjala, successfully collected the dry blood sample, and transported it to the laboratory for diagnosis. Malomo Health Center is located 36 kilometers from Ntchisi District Health Office, and this scenario exemplified the critical role that couriers and HDAs play in ensuring the smooth transportation of samples even under challenging circumstances.

Further, Ernest Manda, Laboratory Technician from Khuwi Health Centre, highlighted how R4H couriers are making a significant contribution to improving patient outcomes. His feedback reflects the importance of the collaborative efforts between HDAs, couriers, and health facility staff in ensuring that diagnostic samples are transported efficiently, leading to better patient care and timely diagnosis.

These testimonies and interactions showcase the impact of the R4H sample transport program and emphasize the ongoing need for improvement in coordination, resources, and logistics to ensure continued success in transporting clinical samples across Malawi’s health centres.

R4H continues to make significant strides in improving healthcare delivery through the implementation of the optimized medical sample transport system in the 11 districts of Phalombe, Mzimba North, Rumphi, Lilongwe, Salima, Zomba, Chiradzulu, Mulanje, Chikwawa, Blantyre, and Mangochi. The Optimized Sample Transport (OST) system utilizes a USSD-based reporting mechanism, where healthcare workers (HCWs) report the number of clinical samples available for R4H courier pickup at the site each working day. Between October and December 2024, R4H route optimization team visited 6 OST implementing districts of Blantyre, Chikwawa, Lilongwe, Zomba, Rumphi and Mzimba North for a support visit.

This initiative started by addressing gaps through distribution of Standard Operating Procedures (SOPs) and Job Aid, for USSD sample volume reporting, to healthcare facilities (HCFs) that fell short of them, had worn out or got lost, and administering of checklist.  In addition, hands-on training sessions, were carried out, to ensure that HCWs were proficient in using the USSD system.  Followed by on-site supervision, to monitor the effectiveness of reporting procedures, and ensure HCWs adhere to the best practices outlined in the SOPs. 

The interaction, enhanced coordination that creates a sustainable model for ongoing support, which included activating contacts numbers for new HCWs, and new phone numbers, to ensuring that all HCWs receive timely SMS reminders for USSD sample reporting, and daily notification of ST courier visit to the facility among others.

The outcomes include the distribution of USSD SOPs at targeted HCFs, training and retraining of HCWs on USSD sample reporting, and the establishment of a strong relationship with HCWs, for continuous implementation of OST program activities. Additionally, HCWs demonstrated a stronger appreciation of the USSD reporting system, with many taking on mentorship roles to train their colleagues.

In the quarter of July to September 2024, R4H made significant strides in improving healthcare delivery through the implementation of the optimized medical sample transport system in the 11 districts of Phalombe, Mzimba North, Rumphi, Lilongwe, Salima, Zomba, Chiradzulu, Mulanje, Chikwawa, Blantyre, and Mangochi. Healthcare workers in various health centers are commending the system, for enhancing the efficiency and quality of medical sample logistics, ensuring quicker diagnostic results and better patient care.

Augustine Mamala, healthcare worker from Mbalama Health Centre in Mangochi, shared his experience: “Before the introduction of the Optimized Medical Sample Transport Program, we relied on scheduled days for couriers to collect samples from the health centers. Now, we use the USSD system to notify the couriers when samples are available, and they report for collection either on the same day or the next, depending on the time the availability of samples is reported.”

The OST system utilizes a USSD-based reporting mechanism, where healthcare workers (HCWs) report the number of clinical samples available for R4H courier pickup at the site each working day. The new system has empowered health workers to manage the sample collection process better, reducing delays and ensuring that samples are collected in optimal conditions for accurate laboratory analysis. R4H’s initiative supports the Ministry of Health’s efforts to improve healthcare logistics, particularly in ensuring that medical samples are transported promptly and remain in good quality until they reach the laboratory.

Alfred Kamwendo, health worker from Kadango Health Centre, commented on the remarkable improvement in turnaround times. “Before the optimized sample transport system, the turnaround time could reach up to seven days. Now, this has been reduced to 2-3 days, which is a big improvement. It has minimized the risk of sample compromission, especially for sensitive samples like sputum for Tuberculosis, which could easily get damaged before reaching the laboratory for GenXpert testing. The same applies to VL (Viral Load) samples – once results are ready, couriers are notified, and they promptly collect and transport them to the health centers.”

By ensuring timely transportation of samples, R4H has improved the challenge of needing to redraw blood and sputum samples due to deterioration, significantly enhancing the efficiency of health care delivery. This program has not only improved diagnostics but also reduced patient stress, as health workers no longer have to request repeated sample collection.

In partnership with the Ministry of Health, R4H is committed to continuously improving its services, striving to deliver quality healthcare logistics to all Malawians.

Between July and August 2024, R4H’s Programs and MEAL team conducted a Spot Check and Data Quality Assessment (DQA) exercises across six districts of Chikwawa, Nsanje, Salima, Nkhotakota, Kasungu, and Chitipa. This exercise aimed to gather feedback from healthcare workers at 108 health facilities; 35 in the Southern region, 36 in the Northern region, and 37 in the central region.

Healthcare workers praised R4H couriers for their professionalism and effective communication. The couriers have been instrumental in the timely transportation of medical samples, reducing the Turn- Around Time (TAT) which was usually 3- 5 days to 2 days. According to Silida Mkokamasa, the Environmental Health Officer for MAFCO, the optimized sample transport system has significantly streamlined healthcare delivery. She highlighted the effectiveness of the USSD system used to report sample availability. The OST system uses a USSD-based reporting method, allowing healthcare workers (HCWs) to report daily on the volumes of clinical samples ready for pickup by the R4H courier at each site.

Lucy Chiyenda, R4H Country Director (L), Silida Mkokamasa- Environmental Health Officer (HEO) and Alice Mbozi- R4H Central Region Sample Transport Coordinator during spot check activity at Malawi Armed ForcesCollege (MAFCO) in Salima district

 

Mkokamasa shared an incident from the April-June 2024 quarter where a courier, collected Viral Load samples in the morning, and promptly returned later the same day to collect a newly reported TB GeneXpert sample through the Unstructured Supplementary Service Data (USSD) system, ensuring swift transport to Salima District Hospital for diagnosis. She stressed the importance of timely sputum transportation for TB diagnosis in preventing spoilage and the need for sample redraws. Efficient transportation of TB samples is crucial as delays can compromise sample integrity, leading to inaccurate diagnoses and affecting patient outcomes.

Fatsani Salamba, an HIV Diagnostic Assistant at Thavite Health Center, added that in June, R4H couriers played a crucial role in urgently transporting Quality Controls (QCs) for Dry Tube Specimen (DTS) needed at the health facility. He further mentioned that when the USSD system is down, they use a WhatsApp forum to notify couriers, who respond promptly. Salamba pointed out that there is need for better coordination among healthcare workers to ensure no samples are left behind when couriers arrive.

These testimonials highlight R4H’s crucial role in overcoming challenges to ensure accessible healthcare in Malawi.