ZERO BREAKDOWN MOTORCYCLE FOR RURAL HEALTH DELIVERIES

IN FLORES, INDONESIA

ANNUAL REPORT DEC, 2007

Executive Summary

HfA has been implementing the Zero Breakdown Motorcycle Program in East Flores for over five years District, East Nusa Tenggara Province, Indonesia. 5 subdistrict becomes the operational areas. In implementing the program HfA gains successes and encounters obstacles yet the program is moving forward and a large number of people coming from 5 subdistricts, which are the operation areas, benefit from it. In the same manner, field health workers gravely feel supported as with HfA motorcycles they can reach remote villages and deliver health services to the people even in far flung areas.

1. Brief context

Since 2000, after the fall of Soeharto's authoritarian rule, Indonesia moved to decentralization kind of government wherein most policies in the district level are in the responsibility of district government and legislative members. Indeed this is seen as a progress in Indonesian picture of governance but in many cases basic services such as health and education are still far from improvement. In health aspect there is a national policy about allocating 15% of the district budget for health program, but in reality it is far more below this target which is around 2 - 5 % only. Despite various sectors of the society raise concerns on the matter and demand to increase the budget for health, yet the government and legislative members argue that there is not enough money.

As a consequence the lack of health facilities could be found in many health centers and worse in remote areas. As for the transport, many field healthworkers are not provided with vehicles. Government specifically district health office at times buy motorcycles for its staffs but in many instances there is no good management of these vehicles that they are easily broken down. Facing such a condition, field health workers have hard time to reach people in remote areas. On the other hand people in remote villages also found difficult to access health services in public health centers for there is also limited means of transport.

The presence of Zero Breakdown Motorcycle program is a breakthrough and an alternative to bring health services closer to the people.

2. Project Objective

General Objective

Deliver health services and disseminate health information to the people in the villages using zero breakdown motorcycles.

Specific Objective

• Build network with District Health Office so as, together, to make plan of action starting from planning process, implementation, monitoring and evaluation in order to achieve a common goal
• Prepare trained staffs who can facilitate how to ride motorcycle and how to do basic motorcycle services
• Educate and train health providers in order to be able to ride and do motorcycle services well
• Build network with NGOs working in health issues, people’s organizations and community leaders
• Provide access to health information for the people in remote areas

3. Project Implementation

1. Monitoring Motorcycle and its use

This activity is done regularly every month to ensure that motorcycle is ready-to-use condition. It is also aimed at ensuring that it is properly used for health deliveries and well taken care of by rider and detecting any breakdown so that repair can be performed immediately.

b. Regular Services

Practicing zero breakdown principle, regular service is intended to minimize motorcycle breakdown. Hence regular is conducted based on the kilo meter reached stated in the service guide.Activities done among which are changing engine oil, check spark plug, clean air filter, check spokes and other basic components.

c. Breakdown Repair

This service is done for any motorcycle due to the breakdown. It is normally done in HfA workshop but in specific condition (such as motorcycle cannot be ridden HfA workshop), HfA mechanic has to go directly to the field whhere motorcycle is operated to do the services.

d. Monitor and Check Logbook

Logbook contains activities related to health services done by health riders. It is aimed to know the coverage of services including names of villages visited, categories of patients/clients attended to (such as baby, children, adult, male, female), kinds of health cases suffered by patients, distances (km) reached by health riders. Checking logbook is also the opportunity to evaluate the performance of a health rider.

4. Project Evaluation

Individual

Individual evaluation is conducted every month between HfA staff and health rider at the time of monitoring. This is intended to know rider's performance and to obtain various inputs especially the problems encountered in implementing the program. The output of this process is:

• Sharing of field experiences between HfA field staff and health riders
• Acquire information both obstacles and inputs for program implementation
• There is solution agree upon by both parties in the efforts to overcome obstacles.

Group Evaluation Meeting

This Meeting is done quarterly and participated by all health riders. It is intended to evaluate how far the successes and failures of the program. Out of this process several points noted:

• There is record of successes and failures in program implementation
• There is solution taken in order to overcome shortcomings in program management
• There are imputs for future improvement of the program

Evaluation Meeting with Other Stakeholders

This evaluation is conducted every six (6) months participated by other stakeholders, including district health office, community health cadres, community leaders. The latter two stakeholders are also involved in monitoring the use of motorcycle in the field. Output of such an activity is:

• Motorcycle is effectively used for health services
• There is information from other stakeholders about the performance of health riders.

5. Other Activities

Refreshing on Basic Motorcycle Service

The aim of this activity is to increase the capacity of health riders in order to be able to do basic motorcycle services. By this in case there is problem happening in the field or on the road related to the components of basic servic, a rider can do the repair. This is important because all operational areas are very solitaire and remote and near by repair shop is very rare to find.

Training on How to Ride Motorcycle for New Health Rider

Many health riders have less knowledge and skill of how to ride motorcycle well and properly. Hence, in case a health rider has a new assignment (such as move to another area, pursue further study or retired), HfA motorcycle is offered to another staff of the same public health center. The new rider has to undergo riding training including technique of how to ride well. Output of this activity is:

• Health rider gains ability to ride with good riding technique
• Health rider is able to deliver health services using motorcycle.

Coordination Meeting

Coordination meeting is undergone with other related institutions both government and NGOs related to the program being implemented by HfA. Outputs of this activity are:

• There is common perception towards the program developed by HfA
• There are inputs from other organizations for future development of zero breakdown motorcycle program
• Know the programs of other partners

Build Network

This activity is used as means to share ideas and experiences with other institutions and at the same time to promote HfA aand its program to other partners. With so doing, HfA existence is socially acknowledged by other parties, especially government institutions, health offices as implementing partner in particular and NGOs working in health issues.

Workshop Development

This activity is an efforts to equip the workshop so that it can effectively give services to the health riders and the public that wants to make use of HfA workshop services and at the same time to generate local fund. Such a fund serves as reserve fund that can back up the need of the organization.

6. Result

With regards to the health services delivered the following is the coverage achieved in 2007. The data are gathered from the riders logbooks.

7. Obstacles:

• Lack of workshop equipment, such as welding mechine, press machine which can hinder smooth working of HfA mechanic in repairing breakdown.
• Several kinds of spareparts that are relatively expensive ones are not available in the area that when we need them it takes time to order before repairing
• Geographical and topographical condition of East Flores region also becomes an obstacle in having communication with field health riders. Even though most health riders have already had hand phones/mobile phones, not all areas has good phone signal. That is why often times it is difficult to communicate when there is an urgent need.
• The majority of field health providers in subdistrict health centers are female who prefer small/scooter type motorcycles. Currently HfA motorcycles are only taller type, namely Yamaha YT 115. As a result only male health providers can ride them. In local Indonesian culture women normally do not ride taller motorcycles and in addition it does not practical with the skirt which is part of the national uniform.

8. Lessons Learned

• It is crucial to work with government specifically with MoH to ensure the sustainability of the program
• Health riders are cooperative with regards to the maintenance and reports of the activities. In Indonesian context at times it is difficult to for an NGO to monitor/evaluate the works of governernment employees and even to ask reports from them but in HfA case it could well be coordinated.

Next -->