The Motorbike Outreach Model: A “Roaring” Success in Kenya’s North Eastern Province
In Hollywood films, the motorcycle is often synonymous with youth, rebellion, and leather-clad individuals cruising the streets in search of trouble. But deep in the hinterlands of Kenya, the motorcycle is fast becoming associated with a far more positive image—saving lives. Since 2007, the USAID-funded AIDS, Population, and Health Integrated Assistance II North Eastern Province (APHIA II NEP) Project has used several innovative strategies to deliver immunizations, medical supplies, and integrated HIV, tuberculosis, and family planning services to some of the hardest-to-reach populations in the world. In recent years, its motorbike outreach model has become one of its biggest success stories.
Kenya’s North Eastern Province (NEP) is one of the most sparsely populated regions in Africa, with an average of 10 inhabitants per square kilometer in a land mass of 126,902 km2 (22 percent of the country’s total surface area). The population mainly consists of nomadic pastoralists who continuously travel with livestock across the semi-arid terrain in search of water and fresh pasture. The migratory lifestyle is a major impediment to the standard model of healthcare delivery, a challenge exacerbated by NEP’s poor physical infrastructure. In the dry season most roads are bumpy and slow, while in the wet season they are virtually impassable; paved roads do not exist outside the capital of the province. Finally, the health facilities scattered across NEP suffer from chronic understaffing that often leaves outposts empty for months at a time.
Consequently, the health statistics in NEP are grim. Immunization coverage is 60 percent (compared to 64 percent nationally) and 33 percent of infants are underweight. Infant mortality (57/1,000 live births) and under-five mortality (80/100,000 live births) are among the highest in Kenya due to diarrheal diseases, anemia, and malnutrition. Family planning use is extremely low at 4 percent.
Although the image of healthcare providers using motorcycles to carry vaccines across rural Kenya might not appear on the silver screen any time soon, the public health impacts of this innovative model are more real and heartening than any Hollywood ending.APHIA II NEP supports a wide range of activities addressing HIV, AIDS, tuberculosis, reproductive health, and healthy timing and spacing of pregnancies in this remote stretch of Africa. The motorbike outreach model is one of the most innovative of these programs, in part because it overturns the traditional model of static healthcare delivery. Starting in June 2008 at five health facilities in Garissa, Lagdera, and Wajir districts, APHIA II NEP used motorcycles to bring health services to the people instead of waiting for people to come to clinics. The motorcycle is, in many respects, the ideal vehicle for traveling across the rough terrain of NEP, which is often inaccessible to cars and larger vehicles.
In this program, motorcycles are used for community mobilization, immunizations, and the transportation of staff and supplies to distant health outposts. As emergency transport, the motorcycles have already had a profound impact. In one instance, a pregnant woman in a distant village was having trouble giving birth. Several men ran to the local health dispensary for help. A nurse at a nearby facility was able to take a motorcycle to the village and assist in the delivery, thus saving the lives of both mother and child. In another example, the KEPI refrigerator in one facility malfunctioned and risked spoiling all the vaccines inside. Fortunately, the health facility had a motorcycle on the premises, and the vaccines were successfully transported 30 km away to a district hospital for cold storage.
The successes of APHIA II NEP’s motorbike outreach model are more than anecdotal, though. By visiting distant health outposts and villages on a regular basis, the motorbike program has had a positive effect on the health behaviors of entire communities. From 2008 to 2010, the uptake of antenatal care in Benane, Shanta Abaq, Korakora, Saka, and Modogashe has increased between 100 to 300 percent. By promoting integrated HIV, reproductive health, and immunization services in areas formerly lacking in healthcare delivery, the motorbike approach has become a rallying point for all priority intervention programs, especially maternal, neonatal and child health; family planning; HIV; and, tuberculosis.
The motorbike outreach model has the added benefit of being extremely cost-efficient. Compared to the 150,000 Kenyan shillings (approximately $150) per week it costs to operate a five-man vehicle outreach program, the 9,800 Kenyan shillings per month for motorbike outreach is a bargain. In addition, most NEP facilities already are equipped with motorcycles, further reducing the start-up fees for the program.
APHIA II NEP has since rolled out the motorbike outreach model to 48 health facilities across NEP, and it can serve as a template for any country with hard-to-reach nomadic populations. This program has shown that a low-cost, high-impact, sustainable intervention can successfully address the unmet needs of remote communities while quickly improving health indicators. Although the image of healthcare providers using motorcycles to carry vaccines across rural Kenya might not appear on the silver screen any time soon, the public health impacts of this innovative model are more real and heartening than any Hollywood ending.