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Healthcare Workers In The Southern Region Of Malawi Embrace The R4H-Optimised Sample Transport System

In the past 6 months, there has been a successful implementation of the Optimized Sample Transport (OST) program by R4H across 11 districts in Malawi. The districts include Phalombe, Mzimba North, Rumphi, Lilongwe, Salima, Zomba, Chiradzulu, Mulanje, Chikwawa, Blantyre and Mangochi. Operating on a pull system, health facilities notify R4H couriers to collect samples upon confirmed availability. This is done by recording the number of available samples in R4H’s USSD reporting system which operates on phones by HIV Diagnostic Assistants (HDAs) and Health Surveillance Assistants (HSAs) who handle Viral load (VL), Early Infant Diagnosis (EID), and TB samples.

The unstructured supplementary service data (USSD) messages generated by healthcare workers create demand for sample collection. The couriers now only visit health facilities when they are notified of the availability of samples at the facility, significantly reducing turnaround time, empty trips, wastage of resources and wear and tear.

A total of 44 health facilities were visited during the sample transport spot checks and data quality assessment exercise that took place from February to March 2024. The exercise was conducted in Mangochi and Zomba districts aiming to assess the effectiveness of the sample transport program and inquiring on the challenges faced by healthcare workers in accessing the USSD reporting system.

The OST system has refined healthcare logistics in Malawi, improving the efficiency and effectiveness of sample transport and diagnosis. Omar Chingomanje, the site supervisor at Jalasi Health Centre in Mangochi, highlighted the reliability and effectiveness of the OST system. He praised R4H for the improved Stage 1- TAT: from the day that samples are drawn from clients to the day that couriers collect the samples from the facility to the laboratory. Using the USSD reporting system, the TAT has been reduced from 3- 5 days to 2 days. “This improvement is ultimately enhancing healthcare service delivery at the grassroots level” concluded Chingomanje.

Similarly, Mark B Mmwala, HSA for Mtimabi Health Center which is located 42kms from Mangochi District Health Office (DHO) praised the system’s reliability and effectiveness.

Through spot checks and data quality assessments, R4H ensures the effectiveness of the OST system in improving sample transportation and addressing the challenges faced by healthcare workers.

With positive feedback from healthcare workers like Chingomanje and Mmwala, R4H is eager to continue enhancing the OST through improved USSD sample reporting to ensure quality healthcare delivery nationwide.


Saving Lives With R4H’s Medical Sample Transport Program

In March 2024, healthcare workers in 123 health centres of Zomba, Thyolo, Mangochi, Dedza, Mzimba North, and Nkhatabay districts lauded the R4H Medical Sample Transportation Program. Davie Jere, HSA at Dzindevu Health Center in Dedza, emphasized how the program fills the gap in providing timely clinical sample transportation to the laboratories and results back to the health facility. For instance, TB samples and EID-positive results are swiftly transported, aiding prompt clinic decisions. Feedback from other health facilities like Chintheche Health Centre in Nkhatabay and Hoho Health Centre in Mzimba district echoed appreciation for the program’s efficiency in sending samples to the laboratory and delivering results back to the health facilities in time.

Some of the notable successes where R4H couriers assist health facilities are cases where they transport other samples like Plasma which were missed out by the facility transport. This happened at Namwera Health Centre in March 2024, where Felix Masakasa, R4H Courier was asked to transport a Plasma sample to Mangochi District Hospital when it was realized that the facility transport had already left for the DHO and the sample was left out. Similarly, it was reported that R4H couriers also play a vital role when there are emergencies requiring immediate administration of treatment, for example, on certain occasions couriers are sent from Mtakataka Police Training School in Dedza which is situated 43 kilometers away from the DHO, to collect medicine from the District Hospital when needed immediately.

It is encouraging to hear healthcare workers express their satisfaction with the Sample Transport program and highlight any challenges for improvement, ultimately this is leading to improved clinical sample transportation services by R4H.


Scaling up Optimized Sample Transport: Training healthcare workers in 6 new districts

Optimized sample transport (OST) is a method of transporting clinical samples from healthcare facilities to the hub using demand created through healthcare workers generating unstructured supplementary service data (USSD) messages. Before October 2023, OST was implemented in five districts of Phalombe, Mzimba North, Rumphi, Lilongwe, and Salima. In December 2023, R4H scaled up the OST to six districts of Zomba, Chiradzulu, Mulanje, Chikwawa, Blantyre and Mangochi. These districts were selected based on the high HIV burden, the possibility of plasma HIV viral load scale-up, high volumes of antiretroviral (ART) clinics, and longer distances from the health care facilities to the hub.

As part of the OST scale-up, R4H conducted USSD clinical sample volume reporting training for a total of 710 healthcare works drawn from 238   healthcare facilities in the six new OST scale-up districts. The participants included the health care facility in charge, HIV diagnostic assistants (HDAs), and the facility TB officer.    The training took place from the 7th to 21st December 2023. The OST scale-up will introduce system efficiencies such as timely pick up of samples from health care facilities to the hub, reduced empty trips, and efficient usage of fuel plus motorcycles.


Sample Management and Motorcycle Riding Training


From 18th to 29th December 2023, R4H hosted a sample management and riding training program for new couriers . The training was conducted at R4H Head Office in Lilongwe for the new couriers who have been placed to work in Salima, Lilongwe, Dedza, Mangochi, Blantyre, Mulanje, and Chikwawa.

Zwelithini Golowa, ICT Officer presenting on CommCare reporting system to the couriers

 While some couriers such as those from Blantyre and Mangochi were deployed to address the high volumes of samples in these districts, others joined R4H as replacements for couriers who left the organization. The training program covered diverse areas such as HR and administrative procedures, riding skill assessments, eye tests, and protective clothing.

Additionally, they attended presentations on sample management, biosafety measures, and COVID 19 which was facilitated by representatives from the Ministry of Health, ICT and
Commcare presentations were also conducted alongside accounts and an orientation on the waste management project.

Overall, the training program aimed to equip the new couriers with the necessary skills and knowledge needed for efficient sample management in their respective districts.


Enduring Challenges in the flood prone districts of Malawi with R4H Medical Sample Transport Program

In the flood-prone districts of Chikwawa and Nsanje, where medical services are often compromised during natural disasters, a ray of hope emerged in form of the medical sample transport program implemented by R4H.

In the period between January and June 2023, R4H couriers defied the odds by ensuring the transportation of viral load and Early Infant Diagnosis (EID) samples to the Nsanje district molecular laboratory. Their unwavering dedication has had a profound impact on the local healthcare system.

During the Monitoring and Evaluation review meeting in August 2023, HIV Diagnostic Assistants (Lab Managers, and other Health Care workers shared experiences, “With R4H’s sample transport program, clients are assisted in time ensuring effective administration of treatment” said Susan Mkanda DHA from Luwe Health Center, Nsanje. Apart from the usual transportation of Viral Load and EID samples, another notable success from January- June 2023 was that clients started TB treatment early, which reduced transmission of the disease” added Steven Macheso from Nsanje District Hospital.

One of the challenges couriers encountered was the scorching hot weather that often engulfs Chikwawa and Nsanje districts. “Tyre punctures during hot seasons and muddy roads during rainy seasons are the major challenges that we face when transporting medical samples” narrated Trinity Lupapa, R4H Head Courier for Chikwawa district. Despite travelling under the relentless sun and enduring the harsh conditions, these determined couriers did not let the weather deter them from their mission. The result was a reliable and timely transportation system that ensured the timely delivery of medical samples and results.

The couriers displayed immense resilience by covering long distances to reach health facilities and the molecular laboratory. The impact of R4H efforts was felt in all corners of Chikwawa and Nsanje districts as medical samples were swiftly transmitted to the laboratory and results back to the respective health facilities. “What excites me the most about my job is the ability to transport samples and results without concerns, that’s saving lives” explained Matthias Semba, R4H Courier for Nsanje district.

With the aftermath of Cyclone Freddy, the challenging terrain of these flood-prone districts further added to the couriers’ testing journey, but their steadfastness surpassed the obstacles and sample transportation remained seamless.

In conclusion, the medical sample transport program has truly been a beacon of hope in Chikwawa and Nsanje districts. The couriers’ ability to overcome the hot weather, reach remote health facilities, and navigate challenging terrains has transformed the local healthcare system. Lives are being saved, and the resilience of these couriers serves as an inspiration to us all.



Healthcare workers applaud R4H Sample Transport Program

The impact of R4H’s Sample Transport Program is being recognized as healthcare workers appreciate the positive changes the program is bringing to the health sector. Patients residing in hard-to-reach areas without laboratories or necessary machines in district laboratories for diagnosis are effectively assisted with R4H Sample Transport Program.

We use motorcycles that are well-equipped with the necessary facilities to maintain the integrity of samples during transportation, particularly in instances where temperature-sensitive medical samples are involved,” explained Shadreck Potipher, ST Courier for Bwaila DHO in Lilongwe. The couriers are adequately trained on standard operating procedures to help prevent any sample from contamination.

Whilst interacting with the Communications Officer for R4H, Mervis Nyirenda on 31st July, 2023 Mary Zgambo, HIV Diagnostic Assistant at Area 25 Health Centre shared how they work with R4H Couriers. She narrates, “We are responsible for testing clients. As recommended, R4H ST Couriers pick up the samples from the health facility after 24 hours.  We document the client’s information in a lab. form and health facility register. The lab form is attached to the sample and is used as an identifier.”

The sample transport program enables patients to receive timely diagnoses and appropriate treatment, which in turn significantly improves their chances of recovery. “The ST couriers also assist in getting clients missing information from the health facility” added Zgambo.

The sample transport program helps to alleviate the burden of laboratory services in some districts by distributing samples to various molecular laboratories across the country. Emmanuel Nthini, Laboratory Data Entry Clerk at Bwaila DHO explains “R4H couriers bring well-labeled samples from other health facilities. The samples are accompanied by a requisition form which comprises the name of the health facility from which the sample has been taken, the date, and ID”.

Currently, there have been improvements in Turn-Around-Time (TAT) from the day samples are collected from a client, and picked by R4H couriers to the day results are ready for pick up at the hub and delivered to the originating health facilities” Nthini complimented.

The decreased turnaround time enables healthcare providers to administer timely interventions and improve patient outcomes.  Nthini concluded “Having molecular laboratories in districts like Mchinji and Salima can assist in reducing the backlog in Lilongwe as samples from these neighboring districts are also sent to Kamuzu Central Hospital (KCH) for diagnosis”.


R4H orients Private Clinic owners on Sample Transport Program

Private clinics are saving time by not having to transport samples themselves, allowing them to focus on their core business of providing healthcare services. On 17th March, 2023 R4H introduced its optimized and scheduled sample transport systems to private clinic owners. The orientation was held at R4H Offices in Lilongwe.

Emmanuel Ngwira, Sample Transport Program Officer orienting Health care workers at Wezi Private Clinic in Mzimba North. Photo credit (Kumbukani Komakoma)

R4H specializes in transporting clinical samples, which ensures that samples are transported efficiently and professionally using 2 systems: Optimized and Scheduled route systems. Lawrence Kachule, Program Manager- Innovation & Digitalization explained “For the Push system, there are scheduled, or fixed routes designed for couriers to visit health care facilities to pick clinical samples and drop laboratory test results. In the pull or optimized sample transport system, courier visits are dependent on demand by healthcare facilities through sending of USSD messages on sample volumes by individual healthcare facilities. Similarly, routes to healthcare facilities are scheduled based on the availability of laboratory test results”.

“It is crucial to transport clinical samples from private clinics to laboratories as quickly as possible to ensure accurate test results” Angellina Nazombe, Programs Manager- Quality Assurance explained.

“With dedicated clinical sample transportation, private clinics can ensure that samples are delivered to the laboratory in a timely manner, reducing the risk of sample degradation and contamination as well as turnaround time. As of end of March R4H has incorporated 26 Private clinics in the Sample Transport Program resulting in a total of 790 health facilities”, added Nazombe.

In conclusion, Shenton Kacheche, Chief Laboratory Scientist from the Public Health Institute of Malawi (PHIM) emphasized on the importance of maintaining quality of samples, Biosecurity and BioSafety when handling samples. In his statement he indicated that with this system we ensure that quality of specimen is maintained. Those handling samples should follow Standard operating procedures so that they don’t acquire infection and also prevent spread of organisms from community and environment. Since samples contain organisms, they should be protected to prevent intentional exposure.



Providing Efficient and Timely Delivery of Diagnostic Services Amidst Cyclone Freddy and other Environmental Challenges

It was just like any other day for most Malawians when we heard the news about cyclone Freddy. The authorities had warned us about its landing in the Southern region, but none of us knew how devastating it was going to be. As the wind picked up the pace, the skies turned darker and the rains became stronger, a lot of houses in the southern region began to creak and shake. Occupants could hear the roof and walls starting to give way until some of the houses fell.

Precious Makono’s house after being hit by Cyclone Freddy- Phalombe district

Precious Makono’s  house ( ST Courier for Phalombe) after being hit by Cyclone Freddy- Phalombe district (Photo credit: Precious Makono)

A state of emergency was declared on the 13th of March 2023. Most victims had to leave their homes, and with each passing moment, their worries only grew stronger. The cyclone affected 11 R4H target districts in the southern region namely, Blantyre, Chiradzulu, Mangochi, Machinga, Mwanza, Mulanje, Thyolo, Phalombe, Zomba, Chikwawa, and Nsanje.

Despite the challenges of the cyclone, the transportation of clinical samples and results from health facilities to laboratories continued. From January to March 2023, 143,909 samples were transported from health facilities to districts or molecular laboratories for diagnosis and 180,833 results were transported back to the health facilities compared to 148,014 samples and 117,870 results which were transported within October to December 2022.  This represents a minimal decrease of 2.77% in samples transported and a 53.4 % increase in the results delivered. Thanks to the courier’s commitment to delivering samples and results with diligence, showcasing their dedication to improving the lives of individuals in remote communities. 

In Mangochi, Lungwena bridge which connects 7 health facilities to the district laboratory was damaged and transportation of samples was only affected in the week of 24th March 2023. The affected facilities include Lungwena, Namalaka, Kadango, Mgola, Makanjila, Lulanga, and Maganga.

Lungwena bridge connecting 7 health facilities to the district laboratory in Mangochi ( Photo taken by Levi Mzumara after Cyclone Freddy)

Even though it might seem like Cyclone Freddy was the only challenge, there are some areas that are hard to reach due to terrain and other geographical challenges. Rameck Chavula; Sample Transport Courier at Mphompha village in Rumphi reports, “We face topographic challenges due to hills and rivers which cover most of Rumphi district. Couriers struggle to transport samples during rainy seasons as most dusty roads become slippery” explained Chavula.

Sample Transport Couriers are crucial, especially during pandemics, where the prompt analysis of samples is vital in achieving accurate diagnosis, and the successful transportation of clinical samples and results during and immediately after Cyclone Freddy and other environmental challenges is a testament to the importance of proactive planning and effective communication in ensuring the sustainability of healthcare.


Riders International and Nigeria team visit R4H Malawi on knowledge sharing mission

In spring this year Riders for Health Malawi team (known locally as R4H) were pleased to showcase their programme and share learnings with a visiting team from Riders International and the Riders Nigeria for Health team. 

Kayode Ajayi, who is both Riders for Health International CEO and country director of Riders Nigeria, was joined in Malawi by Adetola Olaniun, Riders Nigeria programme director. 

Having not visited R4H Malawi since the pandemic, they were eager to learn the latest from Malawi including recent expansion and innovations in the programme.

Mphatso Kachule, outgoing R4H Country Director and Dr Stella Kasirye – R4H Acting Country Director posing with Kayode Ajayi and Adetola Olaniun at R4H Malawi Head office in Lilongwe

The visit kicked off in the capital, Lilongwe with an address by the R4H management team followed by a demonstration of the programme’s sample transport services. 

Sample transport is one of the core services that Riders for Health has developed and offers. Riders is unique in providing a sample transport service that includes appropriate motorcycles that are regularly maintained, supplied with fuel and with full rider training. 

The Riders system means ministries of health and other health focused organisations have a reliable way of collecting biological samples from health centres, transporting them to labs, and then returning the test results to the health centres. Because of this diseases can be diagnosed quickly and treatment, when needed, can start swiftly.

The sample transport service provided by R4H in Malawi is Riders’ most comprehensive. Having started in 2011 with under 10 bikes, it has recently been scaled to cover private clinics and now reaches 790 health facilities and all of the nation’s 29 districts including the notoriously hard-to-reach Likoma Island in the middle of Lake Malawi. 

The visitors were shown the Optimised Sample Transport (OST) which has recently been introduced in Malawi, the only Riders programme that operates this enhanced system. 

Sample transport courier, Prince Kasambala showed how he and other R4H couriers ensure that the samples collected at health facilities match with the results collected from district molecular laboratories. He also showed the level of detail included in the daily reports which provide useful insights into how the system is functioning. 

On the second day of the visit, the visitors were taken to Bwaila and the Area 25 health centres, highly populated areas of the capital, Lilongwe. 

Sample couriers also demonstrated their training in the careful handling of samples, which is essential to ensuring that the best possible samples are delivered to the laboratory for testing.

Prince Kasambala, R4H STP Courier briefing Riders Nigeria visitors on Couriers daily routine at Area 25 Health Center

Thoko Nsema, the head lab technician at Area 25 Health Centre explained the process involved in sample testing, handling and recording from data entry to printing of results. 

Throughout the visit Ajay and Adetola were impressed with the implementation of the new system, and the level of collaboration between R4H, health centres and the Malawi Ministry of Health. They also admired the team spirit and professionalism shown by the Malawi team and the programme’s corporate governance structure.

Riders for Heath’s aim is to continue to innovate and grow. And the hope is that recent developments in the Malawi programme will be adapted to suit the needs of other Riders programmes and used to strengthen Riders for Health’s transport for healthcare programmes across Africa.


Harnessing challenges in healthcare delivery in Malawi

When it comes to accessing quality healthcare services, the tale of most Malawians in hard- to- reach communities has been a story of difficulty and challenge. Through R4H, Chikondi Makawa; a courier from Thyolo has assisted in renewing hope for many Malawians. “I am happy to be working with R4H in its mission to Make the last mile the most important mile in health care delivery. I have been working with R4H as a Sample Transport courier since 2018 and I reach to 31 health facilities” Makawa explained.

R4H previously known as Riders for Health has since 2011 been implementing a Sample Transport program to deal with challenges in health care delivery. In 2011, R4H was operating in 7 districts only: Rumphi, Mzimba South, Dowa, Lilongwe, Machinga, Neno and Nsanje. Currently, STP is reaching to twenty-eight districts in Malawi.

Makawa is not the only agent of change under R4H’s Sample Transport Program. Crispine Hara from Lilongwe east is also one of the couriers who is championing the program in the central region. Hara is a courier for Bwaila District Health Office.

“Sample transport program has been a relief to a lot of people across the country. Before the implementation of this program it was a challenge for community members especially those living in hard- to- reach communities like Chimbalanga and M’bang’ombe to access diagnostic healthcare services like Tuberculosis, Covid and HIV/ AIDS testing” explained Hara. With R4H sample transport Program, this gap has been filled. Couriers pick up different clinical samples like viral load samples from health facilities to district hospital laboratories and molecular laboratories and results back to originating health facilities.

R4H Malawi delivers sample and results transport, medical waste management and road safety training nationally. R4H ensures that universal healthcare is afforded to the most vulnerable at the last mile where access to health care services is still challenged by distance, terrain, and transport. This includes improving diagnostics through the delivery and collection of clinical samples / results. Samples are transported from community health facilities to laboratories by trained R4H couriers. The results are delivered to over 764 health facilities nationwide.

The Programmes Manager Angellina Nazombe explained that the Sample Transport program is promoting a community–wide approach to addressing health equity problems which affect a lot of people in the country especially those who are in living in the hard- to- reach areas.

Reporting on the lessons learnt from the 11 years of implementing the Sample Transport Program, Levi Mzumara, Sample Transport Coordinator for R4H central region, observed that Most of R4H activities are under Ministry of Health hence involvement of government is paramount especially when it comes to decision making on new program activities and other legal requirements. In addition, being a hospitality organization, community participation is key when it comes to activity participation and project acceptance.

As the fortunes of many Malawians change for the better through the Sample Transport program, one only hopes for the continual progression of the programme to benefit more people.