Primary Healthcare Delivery by Motorcycle
Prepared by Simon Milward
The Millennium Motorcycle Ride is my two and a half year solo motorcycle ride around the world. I left Europe on 1.1.2000 and will arrive back home in July 2002 after visiting 70 countries. The main aim is to raise US$100,000 for two medical aid charities: Médecins Sans Frontières and Riders for Health. After eleven months on the road and twenty countries I have raised US$17,000. The former group received the Novel Peace Prize in 1999 for its humanitarian work for populations in crisis. The latter group provides for training of health workers in reliable delivery of services by economical motorcycle in rural Africa. When motorcycles are operated within a system, health delivery is improved by a staggering 400-500%.
I am a keen motorcyclist, being the General Secretary (on sabbatical) of the European street riders' association FEMA in Brussels Belgium, which defends and promotes the interests of riders at the heart of the European Union. During the ride it has become clear that there is an enormous demand for the Riders for Health system in Asian countries: motorcycles can play a major role in saving lives across the region. So although most of the funds raised will be presented to the charities after July 2002, some will be used immediately on a new project on the Indonesian island of Flores.
Some money donated to Riders for Health under the Millennium Ride banner, will be used to send Mr Wilibrordus Bala to the Riders for Health training Academy in Harare Zimbabwe. This was agreed by all concerned. This takes place in January 2001 costing in the region of US$5,000 (or $2000 if RfH waive the training costs).
I hereby request your support for this initiative. If successful it may help millions of people in Asia break the curse of the poverty cycle that lack of access to basic health services means.
INCREASE ACCESS TO PRIMARY HEALTH CARE THROUGH HEALTH FOR ALL (FLORES PROJECT)
As in other developing countries, the problem of health in Indonesia in general is one that needs special attention. Imbalance between the population and existing health facilities brings about numerous health problems. Good health facilities are only found in big cities where people who have money can access such facilities while the poor must face all health risks due to limited access to good health service.
Eastern Indonesia is known as a less attended part of the country. Since the 1997 monetary crisis, it is estimated that 80% of the population here is categorized as poor. This poverty makes their access to good health services more and more difficult. Such a situation deteriorates with limited health facilities. Most health facilities such as public health centers are located in the capital of sub-districts. There are local branches but are not found in all villages, and are difficult to reach due to lack of transport.
It is known that transport is a determining factor to facilitate the people in gaining various accesses including health access. Normally in every village there are roads, although not in good condition, but passable by motors. The problem is most public transport passes on main roads, while entry to the villages must be by foot. Such a situation shows the general picture in villages in Eastern Indonesia.
East Flores located in East Nusa Tenggara Province is part of Eastern Indonesia. East Flores consists of 2 districts namely East Flores and Lembata districts. In both districts there are 249 villages with the population of 276.073 people. In this region there are 1 general hospital, 2 private hospitals, 1 private hospital for lepers and 20 public health centers. Medical doctors are only based in the hospitals.
This data depicts the limited health facilities, while the people are confronted with great health problems such as high rates of malaria, bronchitis, maternal and infant mortality. In addition the cases of STDs are also high considering that many people from East Flores become immigrant workers abroad.
Providing health services that can reach the people especially those living far from the hospitals and public health centers is an effort to help people overcome health problems. The concept of Health for All is a promising and interesting alternative in East Flores, taking into account that many health providers could drive motors and road conditions could allow the riders to reach remote villages.
PLAN OF IMPLEMENTATION
As pilot project of Health for All program in East Flores, 2 subdistricts will be selected, 1 in East Flores and another one in Lembata district. The selection of subdistricts will be based on several conditions: level of access to primary healthcare, the problem of health that can be responded with this program, the number of the existing local health providers and road condition that is passable by motor.
The steps of the implementation of the pilot project are the following:
Available local resources:
- Study in the Academy of Riders for Health in Zimbabwe.
- Making preliminary mapping in order to determine the would-be subdistricts selected.
- Socializing the program to different sectors, especially to the department of health in order to obtain inputs including the information about available local resources that can be used in implementation.
- Forming a working team including exploring collaboration with Riders for Health England for making action plan and looking for sponsor.
- Prepare field team with trainings needed.
- Build wider network particularly NGOs and institutions working in health issues in Indonesia for the purpose of dissemination of the Health for All approach.
- Health providers who are ready to do outreach work in remote areas.
- Habit to drive motors.
- There is Eastern Indonesia Women's Health Network that will give give support for capacity building of outreach workers especially in the effort to increase the knowledge of women's health.
Obstacles that might be faced:
- Many health problems that might be handled that outreach workers might feel overloaded.
- Bad road condition due to the weather and poor maintenance.
- Difficulty to find sponsor particularly in providing motors to match the number needed.
- Government, specifically department of health shows less concern for the program
III. Training Schedule
International Academy of Vehicle Management, Harare, Zimbabwe
Although there will be many kinds of students at the academy, and they will be working in a wide range of programmes, their needs will be much the same. This means that the courses are constructed from discrete 'modules'. The modules cover every aspect of what we have learned over the years of managing vehicles of all kinds under very difficult circumstances.
Special needs and circumstances
The factors that will condition the transport resource management programme:
- The country's infrastructure
- The roads
- Supply of replacement parts
- Supply of fuel
- Price of fuel
- Fuel quality
- Management of vehicles
- Appropriate vehicle - four wheeled vehicles, motorcycles or boats.
- Vehicle limits, etc.
- Introduction to Transport Resource Management (TRM)
- Introduction to zero-breakdown: costs and benefits
- The modular system of vehicle management used in TRM
- The vehicle - production standards and natural mechanical life
- Choosing and buying vehicles: appropriate technology
- Managing fuel, lubricants and replacement parts
- Using local skills and resources
- Managing large fleets
Day three / four / five
- Training as a trainer of drivers
Day six / seven / eight
- Training as a trainer of motorcycle riders
- Basic accounting for vehicle management
- Using vehicle tracking software
- Vehicle use planning
- Ensuring effective service delivery to the community
- Gender in vehicle use and management
- Working with multi-lateral donors, NGOs and others
- Sharing skills and building networks
- Working with RfH and other partners
IV. Curriculum Vitae
Jl. Cak Doko 25, Oebobo, Kupang, NTT
Experienced in the development and management of community based services, with an emphasis on health, social development and human rights in marginalized communities. Strengths in strategic planning and management; developing and coordinating NGO forums, facilitation and training; and program design, monitoring and evaluation. 6 years living in the Philippines and 6 months living in Belgium.
Médecins Sans Frontières, Kupang, 1998 - present
Manager, STD, STD/AIDS Street Outreach Program.
Strategic planning and management of street outreach program aimed at preventing STD and HIV infection in female sex workers and their clients, students, prisoners, fishermen, port workers, sailors and public transportation drivers.
Manage team of 6 outreach workers.
Responsible for design and implementation of program monitoring and evaluation, using both qualitative and quantitative methodologies.
Provide training in risk reduction and behavior change for target groups.
University of Indonesia - Ausaid, Kupang, 2000
Researcher of Behavior Surveillance Survey on STDs and HIV/AIDS for high risk groups.
Women Health and Family Welfare Project - Ausaid, Larantuka, 2000
Facilitator of Focus Group Discussions on Primary Health Delivery with Health Providers.
Anti Violence Committee, Kupang, 1998
Founding member, promoting peacefull atmosphere among people coming from different backgrounds.
Private English Teacher, Kupang, 1997 - 1998
Obor Publications, Jakarta, 1997
Translator of books to social issues from English to Indonesian.
Mission Langues, Belgium, 1996 - 1997
Provided support and counseling to the elderly and the youth.
Trinity College, Manila, 1995 - 1996
Professor of Religion
NGO Forum for Prisoners, Manila, 1994 - 1995
Maryhill School of Theology Community Development Program, Manila, 1992 - 1994
Damayang Lagi slum Coordinator and Field Worker.
Maryhill School of Theology, Manila, AB in Theology (equivalent to S1), 1996
Maryhill School of Theology, Manila, Courses in Philosophy (prerequisite for AB in Theology), 1990 - 1992
San Dominggo Seminary High School, Hokeng, Flores Timur, 1997
Native Indonesian, Native Lamaholot (local language of East Flores), English, Tagalog/Pilipino, French.
V. Budget considerations in US$
Training in Zimbabwe 5,000 To be paid by Millennium Ride funds confirmed (US$275 per day inclusive, plus air travel & incidentals) Flores project proper Motorcycle fleet ? Current sponsor request to Indonesian producers Lifetime running costs per m/c 2,000 Based on Africa experience, see below Fleet administration costs ? Salary & 'Plan of Implementation' costs, see II above
Sponsoring costs (in Euro) - Bushman/Yamaha AG100 two stroke
1 Euro = 1.05 US$
One-off cost of whole bike: 2000 Euro
Running costs Year Lifetime Spark plugs 2 10 Tyres 80 400 Tubes 5 25 Battery 6 30 Air filter 8 40 Fuel filter 3 15 Chain/sprockets 9 45 Piston kit/rebore 10 50 Clutch overhaul 4 20 Brakes reline 1 5 Other/punctures 6 30 Labour 50 250 Oil/engine 32 160 Oil/gear 4 20 Petrol 105 525 Helmet/clothing 25 125 Insurance/tax 18 90 Total Euro 368 1840
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