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.

 

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”.

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.

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.

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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.

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.

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.

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.

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.

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.

Sample transportation is a crucial aspect of healthcare delivery, and it plays a critical role in reaching out to hard-to-reach areas that may not have access to primary healthcare facilities. In these areas, sample transportation is essential for delivering a wide range of medical samples and results such as blood tests, and urine tests, among others. The overall goal of R4H’s Sample Transport Program is to increase access to diagnostic services in the targeted 29 districts of Malawi. Between October and December 2022, 86 couriers reached 764 Health facilities comprising of Christian Health Association of Malawi (CHAM) Health Centers, Community Hospitals, District Hospitals and Central Hospitals across Malawi.

The use of Motorcycles in sample transportation by R4H has revolutionized healthcare delivery in remote areas that are difficult to reach by conventional means. Through the Sample Transport program, we have contributed to the improvement of healthcare services and disease control in the communities we serve. By providing timely transport for samples and results, we have helped to reduce the spread of infectious diseases and supported early detection and treatment of illnesses such as tuberculosis, HIV, and malaria.

Between October and December 2022, R4H transported 165,657 Samples and 117,870 Results cumulatively. Henceforth, R4H couriers covered 482,811 Kilometers, reaching 764 health facilities with no accident recorded representing 100% success rate.

In addition, R4H continues to transport samples and results from Drop-in Centers (DICs) under ST Program. R4H is transporting DIC Samples and results for 6 districts reaching 19 DICs. The districts are as follows; Lilongwe, Mangochi, Machinga, Zomba, Blantyre, Mzimba North. The transported samples and results from the DICs are for the key population.

The importance of sample transportation is evident from the fact that without it, patients at the last mile may not get access to vital medical care that they need. Additionally, timely and efficient sample transportation can lead to faster diagnosis, treatment, and prevention of various diseases.

R4H remains committed to its goal of supporting sustainable development and promoting health and wellness in underserved communities. R4H will continue to work collaboratively with health facilities, government agencies, and other stakeholders to ensure that its transport program is effective and sustainable.

R4H formerly known as Riders for Health in collaboration with Bwaila rotary club has launched a polio awareness and fundraising campaign month which starts Monday October 24 and ends on November 26 this year.

Speaking in Lilongwe during the launch R4H Programs Manager, Lawrence Kachule said they will be using riders to send polio messages to the people and get donations through them. “We have partnered with Lilongwe cycling crew and Riders anonymous in the campaign, these riders will be riding around Lilongwe and other parts of the country requesting people for donations to help in the polio fight.” Said Kachule. He said R4H and Bwaila rotary are geared in the fight against polio so that the country eliminates the disease.

“This ride is an opportunity to highlight both the plight of polio infection in our country and the roads that R4H couriers travel daily to ensure that samples and results can be transported effectively. Effective sample/results transport contributes ultimately to better diagnosis, treatment, and long-term diagnosis for the Malawian patients.” Kachule.

President for the Bwaila rotary club Dr. Stella Kasirye said they thought of the ride so as to give people awareness of the resurrection of polio in some parts of the world. Dr. Kasirye, who is also a Board member for R4H said the launch of the polio month will end with a big fundraising ride to Salima on 26^th  November. “This was just a launch, bikers anonymous and Lilongwe cycling crew will help us in collection of donations towards polio.” Said Dr Kasirye. Dr. Kasirye has asked people to be cautious with polio and take their under five years children to vaccination centres which the government has introduced.

One of the riders from Lilongwe cycling crew, Griffin Lameck said they thought of partnering with the organizations as they also want to help in raising awareness on polio. “We ride and meet with people, we decided of doing this initiative to help in the humanitarian issues. It maybe someone today but tomorrow it might be me who may suffer from polio therefore we will ride for the cause.” Said Lameck.

Riders for Health (Riders) improves access to health care for rural populations by providing transportation services – including vehicle management, training and support services – to national governments and health care delivery organizations in Africa. Riders enables the existing health care system to be more effective by managing and maintaining a transport network of motorcycles and vehicles, which links the different elements of the health care system together. Certified instructors combine theoretical and practical training to deliver courses at all levels of expertise, specializing in training health workers who utilize vehicles to reach communities, particularly over rough roads and difficult terrain. Workers are trained not only to ride, but also to perform their own maintenance and basic repairs, and to adhere to rigorous safety standards. By equipping these riders with a motorcycle and providing appropriate training and maintenance, health workers are able to increase coverage and enhance health care accessibility to their respective populations. Riders provides additional support services, including supply chain distribution, diagnostic sample transport, and medical emergency transportation.

Source: https://socialinnovationinhealth.org/case-studies/riders-for-health-2

Positive and sustained changes resulting from social innovative approaches depend on interactions between the innovators and the environment, either within small local communities or in larger regional areas, and on community commitment and investment in such programmes. Although van Stam proposed a three-step community engagement process for social innovation, the duration for local adaptation of a given project or approach often depends on the specific intervention being delivered within a community setting. Initial sensitisation about a given health condition and awareness creation within communities, empowerment of local stakeholders, and subsequent skills development, community education and implementation, can be particularly complex for preventive efforts. In contrast, interventions related to logistics, such as improved mechanisms for drug distribution or the delivery of pathology results, may move faster. For example, the Riders for Health initiative, which began operating in Lesotho and extended to Liberia, Kenya, Zimbabwe, Zambia, Malawi, the Gambia and Nigeria, required government support but was not dependent on community engagement for operation and success (https://socialinnovationinhealth.org/case-studies/riders-for-health-2/). Accordingly in this case community engagement followed from the success of the intervention, rather than being essential to its introduction.

Source: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00721-3