Riders for Health Skoll Awardee Profile Organization Overview Key Info Social Entrepreneur Barry Coleman, Andrea Coleman Year Awarded 2006 Issue Area Addressed Health Sub Issue Area Addressed Health Delivery Countries Served Gambia, Kenya, Lesotho, Liberia, Nigeria, Tanzania, Zimbabwe Website https://www.riders.org/ Twitter handle ridersforhealth Facebook https://www.facebook.com/ridersforhealth Youtube http://www.youtube.com/user/RidersForHealt hTV About the Organization Riders for Health is an international NGO working to improve the capacity and efficiency of health care delivery in Africa. Riders’ vision is of a world in which no one will die of an easily preventable or curable disease because barriers of distance, terrain, or poverty prevent them from being reached. Riders’ mission is to strengthen health systems by addressing transport and logistics—one of the most neglected, yet vital, aspects of development for the health of Africa. Riders for Health manages motorcycles, ambulances, and other four-wheel vehicles used in the delivery of health care in seven countries across Africa. They work with ministries of health, international and African NGOs, private-sector organizations, local community-based organizations, and religious groups, to improve access to health care for over 21 million people. Riders’ programs provide training and employment opportunities to build local capacity. Their network of highly skilled technicians regularly travels to service vehicles in the communities that health workers serve. This means that health workers don’t waste valuable time traveling to a garage when they could be with their patients. Impact Riders for Health reports serving roughly 14 million people, with operations in the Gambia, Liberia and Lesotho, Kenya, Zimbabwe, and Nigeria. Riders has become the Gambia’s de-facto healthcare transport provider, working with the Ministry of Health and Social Welfare to operate around 400 vehicles providing ambulence services, and transporting drugs, vaccines, and health care workers delivering outreach services. The number of villages with access to the country’s Primary Health Care system in the Gambia increased from 546 in 2011 to 722 in 2015. With 120 motorcycles and sample transport in all districts, RFH-Lesotho serves approximately 70 percent of Lesotho’s population. RFH also serves all districts of Liberia and was a key partner of the Ministry of Health’s Ebola response system. RFH-Zambia’s services contributed to the extension and increased reliability of healthcare workers’ services. In a region served by RFH-Lesotho’s 24-hour ambulance service, 100 percent of pregnant women were able to deliver at health facilities rather than at home. Path to Scale Demonstration and Replication. Increase number of institutions engaging Riders’ services. Social Entrepreneur Andrea and Barry Coleman share a passion for motorcycles. Andrea is a former racer and Barry is a journalist and author. Through the racing world, they became involved in fundraising for children in Africa. Visiting the communities served by the charities they supported, Barry and Andrea noticed broken vehicles everywhere, many that could have been returned to service with minor repairs and maintenance. They saw women in childbirth being carried to the hospital in wheelbarrows, one of whom died during their visit. Frustrated that aid agencies abandoned vehicles rather than commit to basic repairs, the Colemans decided to fix the problem themselves. They re-mortgaged their house and founded Riders for Health, to ensure delivery of essential healthcare services to rural Africa, with a Transport Resource Management system that places vehicles on preventative maintenance schedules. The system virtually eliminates breakdowns, reduces costs, and greatly improves vehicle efficiency. By 2006, Riders had served about 10 million people, primarily in Zimbabwe, Nigeria and The Gambia, by maintaining about 1,300 vehicles. Much of this work was conducted through small contracts to provide service to regions or districts, or to vehicle fleets owned by health ministries or international agencies. Riders was also working to raise awareness of how reliable, consistent transport is crucial to effective health care delivery among ministries of health and the international health care funding community. Equilibrium Overview Current Equilibrium DISCLAIMER: Riders for Health's United Kingdom headquarters, which supported and coordinated all Country Programs, closed in mid-2016 due to longstanding financial and other organizational challenges. In the wake of RFH-UK’s closure, the Country Programs recognized the need for an African-led headquarters function, and recently came together to launch a new entity—RFH-International. (More information on the factors that contributed to RFH-UK's closure and the organization's evolution since then can be found in the "Discussion Starter - Awardee Organizational Challenges_v8-15-17" document.) Due to ongoing changes in RFH's organizational structure, it was not possible to obtain comprehensive, RFH-wide information for this Profile. Instead, information was obtained from 3 'representative' Country Programs—The Gambia, Lesotho, and Liberia—that share many similarities but also differ in significant ways. Unless cited otherwise, the content below is based on input from Cherno "Che" Jallow (Program Director, RFH-The Gambia), Mahali Hlasa (Country Director, RFH-Lesotho), and Ngwarati Mashonga (Operations Oversight Supervisor, RFH-Liberia); the content for The Gambian Country Program is most complete. Once RFH-International is fully operational and can consolidate information on all Country Programs, and the Foundation has decided on how to manage its relationship with RFH moving forward, this Profile will need to be updated. Until then, please treat this Profile as an INCOMPLETE DRAFT for INTERNAL EYES ONLY. -------------------- REGARDING RIDERS FOR HEALTH OVERALL Many African countries are not equipped to provide most of their people with the critical healthcare services that they need, due to many factors such as: insufficient funds and investment; low availability of qualified medical personnel; insufficient medicine and other medical supplies; inconsistent geographic spread, and quality, of healthcare facilities; etc. Another common issue, especially for those who are poor and reside in rural areas, is their inability to travel to faraway healthcare facilities (due to cost, effort, time constraints, etc), and for healthcare personnel to travel to patients needing care, which leads to disability, preventable death, spread of disease, and the development of serious complications. This "last mile" of healthcare delivery is also hindered by inadequate road infrastructure as well as vehicle breakdowns due to poor maintenance and management. Proper procurement (of supplies, and vehicles that are suitable to different road conditions), vehicle maintenance, fleet management, driver training, etc is often overlooked by the government, private funders, last mile healthcare providers, and others. REGARDING RFH- THE GAMBIA SPECIFICALLY The Gambia is the smallest country (by area), and one of the most densely populated, in the African mainland. It is ranked 175 out of 188 on the United Nations’ Human Development Index, due to 57% of its ~2M people living in poverty, an average life expectancy of 60.2 years, and other factors. [i] (For example, given that ~70% of the Gambian people rely on rain-fed agriculture, drought-caused crop failures in 2011 and 2013 further increased poverty, food shortages, and malnutrition. [ii]) The country faces several other pressing, long-term development challenges, including: an undiversified economy, a small internal market, limited access to resources, lack of skills necessary to build effective institutions, lack of private sector job creation, high rate of emigration, high population growth (2.1% per year, due in part to a relatively high fertility rate of 3.6 children per woman [ii]), and high disease burden. Although the country’s disease burden has steadily improved since 1990, preventable and curable diseases feature prominently in the country’s top 10 causes of death (by percent of total deaths in 2012): lower respiratory infections (11.3%); malaria (9.7%); tuberculosis (5.6%); stroke (5.4%); birth asphyxia and trauma (4.7%); diarrheal disease (4.5%); pre-term birth complications (4.4%); ischemic heart disease (3.8%); meningitis (3.2%); and HIV/AIDS (2.9%). [iii] Formal health services are delivered primarily through ~60 government health facilities, 47 community clinics, 30 NGOs clinics, and 25 private clinics. (Many private pharmacies, other drug sellers, and traditional healers also serve the Gambian people.) However, there are just 0.11 physicians (as of 2008) and 1.1 hospital beds (as of 2011) per 1,000 people in The Gambia. [ii] Although ~10% of the government’s budget is allocated to the health sector (as of 2011), ~66% of the country’s total health funding comes from international health development partners, which raises concerns over the sector’s sustainability and the tension between the short-term goals of donors (e.g. aid strictly allocated for specific diseases) and the longer-term needs of the healthcare system. [iv] The Gambia adopted its “Primary Health Care (PHC) Strategy” in 1979, to ensure that basic health services are universally accessible to the country’s people. However, the PHC system is not currently well-positioned to provide preventative or curative