David and Goliath

Andrea Coleman

Global institutions have to be reckoned with: they have resources and influence, and the capacity to bring about large-scale change. But sometimes a small organization can do for them what they can’t do for themselves. Unfortunately, it can be uphill work for very large and very small organizations to work together, and the small organization can easily go under before they have learned to do so. Riders for Health is a small specialist NGO in the field of transport for development.

Transport is probably the single most overlooked element in the battle against poverty and ill-health. Without appropriate modern vehicles, for example, the maternal mortality level of one in 14 pregnant women will not be reduced. But, like all small NGOs, Riders is very vulnerable to the whims and changing priorities of donors.

The development movement in Africa is one of the world’s most spectacular failures. Preventable diseases, new and long-established, are rife, life expectancy is falling, poverty gets worse, wars abound and resources are squandered. Yet, time after time, organizations and individuals come up with the same basic solution – spend money. Even Jeffrey Sachs has recently been proposing a course of action that may seem to boil down to the old ‘throw money at it’ approach.

But most people, including Dr Sachs, now know that just spending money won’t work. We have to come up with something different. If the very large organizations with the money and the resources and the very small ones with proven, durable products could learn to work together, that’s one thing that could make a real difference and save a great deal of money. The mega-organizations are too big to move quickly, but they have the muscle. The small groups can move fast, but lack resources to deploy their services on a scale that will make a difference.

‘We can’t reach these people here’

A case in point: Barry Coleman and I (co-founders and joint chief executives of Riders for Health) were in Somalia in 1988. Despite the international agencies attempting to help the ministry of health to deliver primary healthcare, and the resources they poured in, we noticed that no one had given any thought to the management of motorized vehicles. As soon as a vehicle needed a replacement part it was effectively useless. A British nurse told us, ‘We can’t reach these people here. They’re nomads. We don’t have any transport.’ At the back of the hospital compound stood an almost-new $30,000 Land Cruiser, grounded for ever for want of a three-dollar part. It wasn’t the only such case in Africa and it may help to explain why, for all the more or less total lack of achievement in Africa, the UN spends $200 million a year on new vehicles.

We founded Riders for Health on a basic principle: to find a way to get 100,000 kilometres out of a motorcycle, or any other motorized vehicle, no matter how harsh the conditions. We could work out a way of doing that in Africa, and then tell everyone in development how it can be done.

Early stages

At first interest came almost entirely from a few individuals in African ministries of health because they knew, from their experience of growing up in villages and trying to run outreach services with no transportation, that this really was an issue. By 1998, working with the ministry of health in Zimbabwe, we had put in place a national system for vehicle management. It was run entirely by Zimbabweans and the vehicles in it simply did not break down or have any unforeseen off-road time.

It was a breakthrough for primary healthcare in Africa but few others were interested, except a couple of extremely imaginative and determined senior managers in WHO’s Africa regional office (AFRO), by then based in Harare, who had seen that the system worked in Zimbabwe. Again, being Africans, they realized the implications. ‘Can you do it in Nigeria?’ they asked.

In early 1999 the Riders Zimbabwe team took the system to Lagos and trained a Nigerian team to run the vehicles needed for the WHO polio eradication programme. There were 37, one for each state. Now the same team runs 120 vehicles in the polio fleet and looks after more than twice as many for the other UN agencies based in Abuja.

Learning to work together

A happy ending, but it came only after a long period of learning to get through the difficulties that we found in working with WHO and they with us. They didn’t know the first thing about how to look after a vehicle in Africa. Why should they? Their mission is to try to save the world from outbreaks of preventable diseases, like polio. And we didn’t know how to work with a huge multinational agency. They had rules, procedures, departments and even lawyers. And because no personnel in any offices in multilaterals have any idea how much it costs per kilometre to run a double-cab pickup in Sokoto or Akwa Ibom (about 39 cents, today, if you do it right), they were convinced that we were wasting their money (to put it politely).

Now they know otherwise. They have learned to demand the one thing they needed all along, which is quality of service and value for money. And we have learned to deliver it in the way they want and need. WHO were brave and imaginative to work with us and we were tough and determined not to curl up and die in the face of their might. There are any number of small, promising not-for-profits who could do the dozens of things that big agencies can’t do if they only manage to survive the experience of trying.

As we said at the beginning, small, entrepreneurial organizations, whatever the value of their services, are perpetually vulnerable. In the case of Riders, the tsunami has shown just how vulnerable they are in the face of donor whims. We had the experience of ‘funders’ actually writing to us asking for their money (donated in 2004) to be returned with interest so that they could give it to one of the hundreds of bodies, formal and otherwise, collecting funding for unspecified ‘help’ for tsunami survivors.

A partnership worth pursuing

We believe we have a success story worth studying. The polio programme shows what can be done. In another part of the forest, using another approach, a similar body to the Nigeria polio team completely lost 41 vehicles within six months. If the Riders example were repeated throughout Africa, ministry by ministry, programme by programme, we could at last see medieval diseases on the run. There would inevitably be other obstacles, but not those of failing vehicles and a million communities left unreached.

Finally, another success story. In Binga district, in Zimbabwe, a Riders supporter enabled us to buy enough motorcycles to provide one for every single public health worker. Riders trained the environmental health technicians (EHTs) in riding and simple maintenance techniques and then put all their motorcycles in the completely reliable Riders transport resource management system. The ministry gave permission for the new motorcycles to be concentrated in one district to see what would happen and WHO provided impregnated anti-malaria bed-nets and chemicals for spraying. The EHTs delivered the nets throughout the district and supervised the spraying. Academic research suggests that in the year following, malaria deaths in Binga fell by 20 per cent while in the neighbouring control district of Gokwe North, they rose.

That’s a partnership worth pursuing – isn’t it?

Andrea Coleman is co-Chief Executive at Riders for Health. She can be contacted at acoleman@riders.org

See http://www.riders.org

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