Tuesday, 15 April 2014
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A recently concluded two-week discussion on the IAPHL Forum addressed the challenges or solutions for managing vehicles for distribution of health commodities in rural areas. In week one, moderator Matthew Hann from Riders for Health summarized the discussion: "almost everyone mentioned that transport in rural areas was more challenging than anywhere else, which was exacerbated by the fact that the further down the chain vehicles were needed, the less resources they had. My colleague from Lesotho pointed she finds it challenging when people begin projects in rural areas want to see quick results, and reach many people within a short time, despite the fact that it could be more expensive and time consuming to reach a smaller number of people in rural areas. "Several contributors reported that vehicles in rural areas were more likely to suffer mechanical breakdown and downtime, and that it was often the case that there were often far fewer vehicles actually in operation than officially listed, or vehicles such as ambulances had to be diverted to act as delivery vehicles. This is something that we have routinely come across. "Several contributors went on to look at the merits of outsourcing transport to 3PL providers, who are able to bring vehicles management skills and allow ministries of health to focus on the delivery of health care, and there was some good advice for how we can best market these services to organisations who might be reluctant to consider outsourcing. "But I think the most important point raised was that whatever vehicle is being used, and whatever system for managing them, the thing that underpins any successful programme is adherence to the principles of basic maintenance, financial management and operational management. Unfortunately, in our experience while there is a growing acceptance that vehicles need to be purchased, these underpinning management structures are forgotten, which results in the failure of vehicles mentioned above." In week two, Hann continued: "We have had contributions addressing many of the challenges faced by those of us running vehicles in rural areas in what is commonly known as ‘the last mile’ as well as some excellent examples of solutions and best practice. "Over this final week we have highlighted that one of the biggest challenges we face is securing a budget that will allow people to run systems of preventive maintenance, as it is clearly more cost effective and efficient to carry out maintenance on a preventive rather than reactive basis. Both in terms of financial efficiency but also in the efficiency and effectiveness of service delivery. "Before wrapping up, I want to give two examples of where we have been able to work with partners to implement successful vehicle management systems for health providers. "Where Riders for Health is proving a full service leasing model in The Gambia, we are showing that ministries of health can provide a more reliable service to their whole population, based on a fully managed and reliable vehicle fleet. It allows us to carry out outreach, emergency transfers, logistics and deliveries. Since 2009 our fleet there has travelled over 10m KM with no preventable breakdowns. The mix of motorcycles and emergency referral ambulances and trekking vehicles mean that each health centre has the mix of vehicles appropriate to them. "In Lesotho we worked with partners to develop a system of motorcycle couriers for medical samples in rural areas. This system has now been successfully replicated in several other countries. Both of these examples are based on systems of preventive maintenance, and outreach servicing – taking our technicians to the places where vehicles are operating, rather than needing them to visit a central workshop." To view the entire discussion, please log on to (or join IAPHL) and then click on the link: https://knowledge-gateway.org/iaphl/discussions/36a3e85c There are also summaries from many recent discussions at http://iaphl.org/iaphl-listserv
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