The Skoll Foundation will provide credit support of $3,500,000 Program Related Investment (PRI) to cover the purchase of a fleet of 224 vehicles (motorcycles, double-cab pick-ups, and ambulances) which will be leased to the Gambian Department of State for Health (DOSH). These vehicles will be put into the established Riders for Health fleet management system in the Gambia, allowing Riders to help the country to occupy a unique position as the first African country to have total health coverage for its entire population - every man, woman, and child. It will therefore also be the first country to show the impact on the health of a nation when health resources reach the population reliably and over time. The program will also optimize vehicle maintenance and performance and work to create a replication model for vehicle leasing across Africa, for which the Skoll Foundation has already provided a non-repayable $400,000 grant linked to the PRI. Other components include: opening an additional workshop/garage in Gambia to extend its outreach network; developing an apprenticeship program to train new mechanics in Riders' vehicle management system; designing a monitoring and evaluation plan to fully document the pilot project; and hiring executive level staff in the US with expertise in international development to raise Riders' visibility among global health funders, multinationals, and international NGOs.
Riders for Health provides comprehensive maintenance and management for fleets of vehicles used by health workers in Africa to bring essential healthcare services and preventative health education to rural populations. Riders-managed vehicles currently allow health workers to reach nearly 11 million Africans in Gambia, Zimbabwe, and Nigeria. It also provides support services for vehicles in Kenya and Tanzania.
Health workers in the Gambia and across Africa are each responsible for up to 20,000 people. The population is thinly spread and only 30 percent of people live within two kilometeres of a road. If Africans are to have access to the health resources available, then health workers need vehicles, and those vehicles need to be appropriately designed for harsh, unmetalled terrain. The DOSH, in common with health ministries across the continent of Africa, has no coordinated vehicle servicing or parts replacement system. Without these resources many people in rural villages are left without access to even the most basic, life-saving healthcare provisions - including immunizations, water sanitation training, and disease diagnosis.
To ensure this program is operationalized, the Skoll Foundation has agreed to a $400,000 grant to build capacity and internal infrastructure, and a Program Related Investment (PRI) of $3,500,000 in the form of a loan, loan guarantee or combination thereof. A condition precedent to finalizing the PRI is a funding agreement between a bi-lateral donor, which Riders seeks with a CGI member, Riders, and the Gambian Department of State for Health, that would cover the cost per kilometer, including capital costs and interest, for the whole fleet during the leasing period.
Additional cost: $10,700,000 from bilateral donor-at an average of $2,140,000 per year - some paid to the Department of State for Health the Gambia and some to Riders. Includes transport, labor, cost per kilometer for the fleet, and supplies for health care for all Gambians for duration of the commitment.
MEASURES OF SUCCESS
Working with partners, Riders for Health will use both quantitative and qualitative analysis to measure success at each level of the commitment, particularly in relation to:
1. Fleet performance
Riders for Health will monitor and evaluate all elements of fleet management and performance to ensure that:
- zero-breakdown standards are maintained for the entire vehicle fleet
- the delivery of health care is never disrupted by the unavailability of transportation
2. Health indicators
Riders for Health will work with DOSH and other health-focused agencies on health data to monitor the impact on:
- health worker mobility (number of beneficiaries reached and frequency of visits)
- achievement of health targets, both for individual health workers and at national level
3. Improvement in hitherto derelict health systems.
This initiative will ensure that the Gambia is the first country in Africa to prove the positive health impact occuring when resources reach the entire population reliably and over time. Riders for Health will measure how this initiative impacts the international development community's perception of the importance of health systems, and the need for new, practical ways of delivery health resources.
4. Increased cost-effectiveness of healthcare delivery
Using a combination of logistical, financial, and health data, Riders for Health will measure the financial impact of their initiatives on:
- the conservation of resources and cost-effectiveness of healthcare delivery (number of health workers mobilized within the program budget and achievement of health targets against cost)
- whether the cost benefits encourage increased investment in health and development from new and existing investors
Anticipated Launch: January 2008
- Secure the agreement of the Gambian government at presidential level in support of the initiative (complete)
- Prepare capacity for Riders for Health the Gambia to manage and monitor the three aspects of the increase in fleet: technical, financial and administrative (complete)
- Design the monitoring and evaluation plan (currently under development)
- Secure donor(s) to fund running costs of the vehicles
- Conduct base-line study for ongoing monitoring and evaluation against four criteria - technical, financial, mobility (impact on health workers and community) and health
- Open an additional workshop (up-country) to extend outreach maintenance network and capacity
- Purchase the first half of the fleet and put in position under management of Riders' existing system of vehicle management
- Begin repayments to the Skoll Foundation
- Hire staff in the U.S. (see commitment overview)
- Conduct first evaluation (year one)
- Purchase second half of fleet and put in position
- Conduct second evaluation (year two)
- Final evaluation (year three)
Riders is all about partnerships and is focused on the principles of cost-effectiveness, strengthened health systems and sustainability for its partners. By outsourcing transport maintenance and management to Riders, health partners can focus on their core-competency of delivering high quality health services.
Riders works closely with health implementers (governments, international NGOs, bilateral and multilateral agencies) to build their capacity in health transport optimisation - from planning health budgets to designing appropriate financing mechanisms. In addition to the fact that Riders enable health partners to achieve their health care goals, practical benefits include:
-Highly cost-effective - the Riders' preventive maintenance system is the most cost-effective way to manage transport for health care delivery all the way down to the community level
-Budgeted system - Riders' cost-per-kilometre costing model allows partners to budget for the real cost of transport, not just the upfront vehicle purchase costs
-Reliability - Riders' system allows for consistency and regularly-scheduled trips, improving trust in the system and enabling effective scheduling
-Sustainable - Riders sees itself as a long-term partner of the local health system; charges at not-for-profit rates; promotes local employment
-Systematic - Riders systems are highly-replicable, based on standard operating procedures
- Measurable - Riders M&E systems (in-house and external) allow for target-setting and measurements of success
-Experience - Riders' work and approach in a new country/area is always rooted in considerable experience, as Riders has delivered transport logistics
systems in Kenya, Lesotho, Nigeria, The Gambia, Malawi, Zambia & Zimbabwe.
-Customized - Riders offers several service models for health partners to chose from based on their health needs. (e.g.: outsourced maintenance, leasing, sample courier service, road safety training, consultancies)