Two wheels good

It's small, it's nippy - and it can be fixed in seconds by just about anyone. The Uhuru ambulance reaches parts of the Third World that 4-x-4s can't. Rose George tells its story
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The Independent Online

" You read about a new malaria vaccine and you think, 'Great. Children's lives will be saved.' But they won't if the vaccine ends up stuck in a warehouse," says Barry Coleman. "People know about aid, but they don't think about how it gets there." As co-director of Riders for Health, a small non-governmental group that supplies transport solutions to health workers in Africa, Coleman knows more than most about the "invisible issue" in aid and development: sensible, sustainable transport.

The gleaming white four-by-four - acronym on the side, flag on the roof - may be the image of transportational altruism, delivering aid and benevolence from the First World to the other, poorer parts of the planet, but it's a misleading image. The vehicle of mercy and development is no different to any other vehicle: everything breaks down, sooner or later.

At a meeting of several agency logistics chiefs last year in Holland, it was calculated that, of the 45,000 vehicles they were responsible for, they spent more than $800m (£416m) a year running and maintaining the fleets. The problem is that the NGOs budget for a vehicle, but not for its breakdowns, so they end up spending more money than they meant to. "Maintenance failure," says charity Transaid, "is the greatest cause of operational failure in transport activities throughout the developing world."

Vehicle supply is big business: at trade and aid fairs, competition is fierce between leading dealers like Toyota Gibraltar and Ford, against upstarts like Mahindra and Mitsubishi. But the talk is of accessories and fuel tanks, not hidden maintenance costs or the fact that the punishing climates the vehicles work in can lead to breakdowns after only a year. George Fenton, the logistics director for World Vision, a huge NGO at the meeting, admits the money includes "a lot of waste".

Partly, this is due to naivety. One four-by-four dealer, when asked how to service his vehicles in Chad, for example, suggested contacting the nearest authorised dealer. There aren't any in Chad, or in many other places in the regions where his vehicles are expected to operate. Martin Dalton, the head of logistics at the Irish agency Concern, makes sure his fleets are stocked with vehicles that can get parts easily, even in Africa, and that can be serviced locally.

But less experienced NGOs are often as clueless as dealers. "They order vehicles with electronic parts," Dalton says. "Ones built to European specifications." And when they break down in Africa, they stay broken. So the more sensible logistics managers keep their vehicles simple: they'll fit extra fuel tanks as standard, because fuel is hard to come by, even in urban Africa. They'll fit VHF radio and desert or mud tyres. "When one part breaks down, it can fail the whole vehicle," Coleman says. "Agencies buy vehicles and expect a blow-up as part of the cost. Well, it shouldn't be. So many programmes fail because the vehicles fail."

This is what Riders for Health is responding to. Already, it runs more than 500 bikes and 500 four-by-fours for the Zimbabwean health ministry. And, more importantly, with its Academy of Vehicle Management in Harare, Riders trains health workers to service their own bikes - five minutes a day; only the simple things like nut-tightening and changing oil filters - in the quest for zero breakdowns.

Now Riders has gone further. The Uhuru (Swahili for "freedom") is a motorbike ambulance, water pump and goods vehicle. Attached to a low-tech 200CC Yamaha, accessories for the Uhuru are locally made in Zimbabwe, including the stretcher and a pop-up seat for women in labour. "Attach the rear wheel to a water pump," explains Andrea Coleman, Riders' other co-director, "and it can pump 120 litres."

Is it comfortable? "Not as much as an ambulance you'd want to go to hospital in," she says, "but it's better than walking 10km or giving birth in a field."

The biggest health problem facing Africans, she says, isn't malaria or TB but exhaustion, which leaves people more susceptible to other diseases. Three-quarters of transport throughout Africa is by foot. The nippy Uhuru - being trialled in 15 Zimbabwean districts and two in Kenya, and usually ridden by female health workers - provides mobility, and that saves lives.

Aid agencies do a great job with the large-scale mechanical deliveries, says Paul Starkey, an export on rural transport, but intermediate transport - the motorbike, the donkey cart - is neglected. "A lot of money goes into building roads," he says, "but not into the intermediate networks and transports that get to the roads. A road is fine for big mechanised transport, but a woman carrying a load on her head needs a good footpath." A district hospital serving hundreds of villages might have one Toyota Landcruiser ambulance. That's all well and good, but most of its patients need to get there by alternative means.

It was on a trip to Somalia a few years ago that Riders for Health was born. Barry Coleman noticed vast numbers of broken-down motorbikes, particularly ones belonging to the Ministry of Health for its outreach workers. "The bikes had 800km on the clock and they told us that the motorbikes weren't suited to Somalia," he says. "It was too dusty, or something."

But, as an experienced motorcyclist, Coleman didn't believe that. The answer, rather, was breakdown management. "There are plenty of skilled mechanics in Africa," he says, "but they weren't trained in preventive mechanics." Riders for Health runs and maintains fleets of motorbikes and 4WDs for the Gambian and Zimbabwean health ministries and UN agencies. It proved itself first by running a 47-motorcycle fleet for the Lesotho Ministry of Health for seven years without a breakdown.

"We knew that any vehicle needs regular interventions, and in Africa there were a lot of enthusiastic and skilled mechanics, but they weren't trained in preventive maintenance," he says. Something must be working: one ambulance has 500,000km on the clock and has never broken down.

An environmental health technician in Zimbabwe, M Marime, told Riders he had covered 90,000km "with zero breakdown". His bike helped to save lives during a cholera outbreak.An outreach worker at Bindura Provincial Hospital, S Zanamwe, was equally effusive. "Your defensive riding training is very good," he wrote. "I have not had an accident since 1998," despite helping 19,000 people and covering thousands of kilometres.

In Binga district in Zimbabwe, there are 10 health workers with motorbikes and maintenance training. In the neighbouring province of Gokwe, there are three. Binga's malaria rates have gone down by 20 per cent in a year; Gokwe's have not. "Look, we're not saying that's down to the motorbikes," says Coleman. "But Binga and Gokwe are similar areas with similar conditions. It might have something to do with it. If you can't deliver the nets or supervise the spraying, it must make a difference."

This holistic message is not lost on the bigger NGOs and UN agencies. Fenton of World Vision has been instrumental in setting up Fleet Forum, with the International Federation of the Red Cross and the World Food Programme. It's the first attempt by agencies to consult on logistics issues.

Fenton hopes this is the way ahead. "We can save significant amounts of money if we manage our vehicles better. But logistics is undervalued, so there's not enough training provided." Logistics isn't sexy; it doesn't seduce aid donors. But it should. Any motorbike stretcher-bearer knows that.