Background

Brief History

During July 2000 Willy Balawala currently Health for All (HfA) Executive Director, conducted focus group discussions with health workers from all public health centres in East Flores District, Flores Island, Indonesia. During the course of the discussion he heard many stories about the bad health situation in the area. A great number of pregnant women in rural villages were suffering from anaemia and were sometimes dying due to severe bleeding during childbirth.

There were also many children suffering from malnutrition. In addition there were many other life-threatening illnesses such as diarrhoea, malaria and TB, that could be medically treated if those in rural areas had adequate access to healthcare.

One of the main factors which exacerbates these health problems is that people in isolated areas lack access to health facilities. People have difficulty visiting health centres due to the limited availability of public transport.

Similarly health workers do not have vehicles that can be used to reach the isolated villages within their area of responsibility. As a consequence, many people die due to the absence of health workers, or people delay referring emergency cases to health centres due to limited transport options.

There were a few motorcycles distributed by Government for operational activites but the problem was that those vehicles were not well maintained and damage was not repaired. Sometimes operational vehicles became personal property which were used for personal needs which meant that the operational expenses of the vehicles should be shouldered by the riders themselves.

There was an absence of a sustainable system that could manage transportation for Mobile Health Services.

In September 2000 Willy (at that point working with Medicins Sans Frontieres (MSF) Belgium happened to meet Simon Milward, in Kupang, West Timor, during Simon's round the world Millennium motorcycle ride.

During their brief meeting they discussed the health issues outlined above and the importance of adequate transport to improve the quality of healthcare for people in remote areas. Willy maintained contact with Simon, who later put him in contact with Riders for Health (RfH) UK.

Willy discovered that RfH had already developed a programme of transport resource management for health delivery in several countries in Africa. Expressing his intention to design a similar program in Indonesia, Simon and RfH then sponsored Willy to undergo training at the programme being implemented in Harare, Zimbabwe in February 2001.

Vision

Health is a human right (World Health Organisation (WHO) declaration in Alma Alta, 1978), therefore every person has the right to access health services. Health for All envisages the realisation of a healthy, vibrant and peaceful society.

Activities

• To provide motorcycles for health workers, specifically midwives and nurses working in public health centres that are responsible for large areas but which have no means of transport to cover these areas. The aim is to provide easier access to health services for those in rural areas, particularly those having very limited access to transport. The use of motorcycles is monitored by Health for All and others such as community leaders, the Ministry for Health in sub-district levels, Non-Governmental Organisations and the public.
• To manage and control the roadworthiness of the motorcycle fleet. This is to ensure that a Zero Breakdown principle is maintained. This is carried out by monitoring the condition of the motorcycles regularly. The health workers responsible for the motorcycles fill in a logbook and the riders themselves are regularly evaluated.
• To conduct regular field monitoring to ensure the proper use of the motorcycles.
• To carry out repairs whenever damage occurs.
• To supply spare parts. To do this Health for All uses parts from its own tock and is refunded by the Health centre or rider.
• To train health workers to ride motorcycles. This training is specifically designed to enable healthworkers to ride properly and safely in local conditions and ensures that they can maintain the Zero Breakdown programme.
• To organise seminars and group discussions on health issues such as reproductive health, nutrition, STDs, HIV/AIDS, etc. Such discussions are open to the general public and aimed particuarly at women's groups.
• Training on Health in the perspective of Gender and Human Rights. Health workers participate in this training with the purpose of widening their horizons with regard to the importance of looking at health in the perspective of gender and human rights.
• To network and to collaborate with Government in order to work more effectvely in partnership, to ensure clear understanding of the issues and mutual support by all parties.
• To network and communicate / work with NGOs, local organisations and community leaders. These groups are involved in monitoring and evaluating the programme and give feedback as to how well the programme responds to the needs of the local people.
• To supply health education and information materials for distribution

Results

• Training at the international Academy for Transport Resource Management in Harare, Zimbabwe facilitate by Riders for Health UK
• Exposure to the programme being implemented in Harare
• Purchase of 12 Yamaha YT115 motorcycles which are used to deliver health services to more than 50,000 people in four sub-districts
• 13 Healthcare workers trained to ride motorcycles and in basic motorcycle maintenance.
• Health deliver riders accustomed to implementing the Zero Breakdown system.
• During the successful National Immunisation Week in four sub-districts, the utilisation of motorcycles was managed by Health for All.
• The decline in malnutrition cases in children under five years old.
• An increase in the number of healthcare worker visits to rural areas to deliver health services such as vaccinations for children and education in good nutrition, health and hygience for mothers and children.
• Intensive monitoring of the Zero Breakdown programme and regular servicing of the motorcycles to ensure the success of the programme.
• An increase in the monitoring of sanitation facilities.
• The ability to respond quickly and more easily to emergency cases.
• Training given to 60 Healthcare workers in Health Services in the Perspectives of Gender and Human Rights
• Dissemination of health information material on subjects such as Nutrition, Maternal and Child Health, STDs and HIV/AIDS.

Further information can be found in the
Health for All brochure.

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