In one of the R4Hs Sample Transport Program implementation areas; Dowa District, Titus Juga stands as a beacon of dedication and service. As a medical sample transport courier, Titus is entrusted with a crucial task: transporting medical samples from 24 health facilities across Dowa to the district health office for diagnosis. Once the results are ready at the laboratory, he promptly delivers them back to the respective health facilities. This cycle of transport and communication ensures timely diagnoses and treatments, saving countless lives.

Juga’s role under the R4H is critical. “The work that I do under R4H is assisting in ensuring that clients are diagnosed in good time and prescribed treatment,” he explains. For him, this responsibility is more than just a job; it’s a calling. “This experience is fulfilling,” added Juga.

The shortest route he undertakes is 9 kilometers from Dzaleka Health Center to Dowa District Hospital, while the longest stretches up to 96 kilometers one way. Despite the challenges posed by varying terrains and distances, Titus remains committed to his task. For instance, the route from Thonje Health Center to Dowa District Hospital is particularly demanding, it is a 36km journey with challenging terrain that demands endurance and determination. Yet, these obstacles strengthen his determination to serve the community.

Juga takes  pride in his ability to serve the community, recognizing the vital impact of his work on the health and well-being of the people in Dowa. “I appreciate all the healthcare workers I interact with in health centres in Dowa,” he says. Their support and organization play a significant role in the efficiency and success of his duties. “They welcome us well and make our work easy with their timely support and organization.” Concluded Juga.

Through his tireless efforts, Jugas  dedication to his role as a medical sample transport courier under R4H ensures that health facilities in Dowa can provide timely and accurate diagnoses, saving lives and fostering a healthier community.

 

 

R4H Couriers are making strides towards a healthier future, aligned with Sustainable Development Goal 3, which focuses on health and well-being. The couriers play a crucial role in the healthcare system by ensuring the swift and safe transportation of medical samples and results between health facilities and laboratories. This ensures timely diagnoses and treatments.

In June 2024, Angellina Mwase, the Programs Manager for Quality Assurance at R4H, embarked on a quality check mission. She scheduled meetings with District Medical Officers at Mchinji and Salima District Hospitals to evaluate the program’s impact. Dr Steria Mlepo, the District Medical Officer at Mchinji, praised R4H for their punctual and adaptable service, noting how they assist in transporting other parcels as needed.

At Salima District Hospital, Francis Chimberenga, the laboratory technician and deputy safety officer, echoed the same view. He highlighted how R4H couriers have significantly reduced turnaround times for medical results while maintaining the integrity of the samples, ensuring they remain intact throughout the medical sample transportation process. This efficiency has markedly improved patient treatment outcomes.

In conclusion, Dr Steria Mlepo commended the exceptional work of R4H and expressed a desire for R4H to expand their operations to additional facilities like Faniwelo and Mphelero, spreading their positive impact even further. Through their dedicated service, R4H Couriers continue bringing hope and efficiency to Malawi’s healthcare system.

R4H’s Optimized Sample Transport (OST) system is transforming healthcare logistics, through improving clinical sample transport times to testing laboratories, in Malawi across 11 districts of Phalombe, Mzimba North, Rumphi, Lilongwe, Salima, Zomba, Chiradzulu, Mulanje, Chikwawa, Blantyre, and Mangochi. These districts were strategically selected due to their high HIV burden, the potential for scaling up plasma HIV viral load testing, the high volume of antiretroviral therapy (ART) clinics, and the significant distances between healthcare facilities and central hubs.

The OST system revolutionizes the transport of clinical samples, ensuring they reach testing facilities on time and with maintained optimal quality standards. The OST system comprises an Unstructured Supplementary Service Data (USSD)-based reporting mechanism, whereby health care workers (HCWs) report on each working day the volumes of clinical samples available for pick up by R4H courier at site. The USSD reports are received centrally and used to generate courier routes for the subsequent day through an OST semi-automated algorithm. Courier routes are based on healthcare facilities (HCFs) with clinical samples to be picked. Similarly, couriers actively inform the R4H OST central team on the availability of laboratory test results to be delivered at requesting HCFs and routes are also generated for site laboratory test result delivery.

Between 29th and 31^st May 2024, as a way of onboarding HCFs on OST, Steven Maluza the OST Program Office Assistant at R4H, embarked on an exercise to orient HCWs at three new HCFs, thus Chilinde Health Centre, Biwi Health Centre, and Bunda College of Agriculture Clinic.

During the initial stages of OST scale up to HCFs under Lilongwe district health office (DHO), HCWs, including HCF in charge, HIV Diagnostics Assistants (HDAs) and TB focal person from each health centres were trained on USSD sample volume reporting system. On any working day, each of the HCFs is supposed to report on the availability or non-availability of clinical samples by 2 pm. The facilities were selected based on their USSD noncompliance status in the month of April 2024. The visit was aimed at providing capacity building to HCWs at site on OST technical areas including USSD sample volume reporting training and retraining, thus, improving the quality of specimen referral mechanisms under Lilongwe DHO. The following HCFs, implementing OST, were visited: Area 36 Drop-in Centre (DIC), Lilongwe Private Clinic, City Centre Clinic, Kawale Health Centre, Ndaula, Nthondo, Area 36 Pvt, Area 18, Likuni DIC, Fidelity, Area 47 DIC, Chilobwe, Mbabvi, Airwing, Ukwe, and Kabudula.

The long-term technical benefits of this exercise include improved USSD clinical sample volume reporting compliance by HCFs, HCWs skill retention on USSD clinical sample volume reporting, improved clinical sample/ laboratory test result transport time i.e., turnaround time and reduced courier empty trips to HCFs.

In conclusion, an efficient OST program implementation improves clinical care standards for ART clients as reduced clinical sample/result transport translate to timely laboratory diagnosis and linkages to clinical care for ART clients.

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.

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.

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.

 

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.

 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.

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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