Madagascar: Getting Health Care Rolling

Photo: Robin Hammond, JSIMAHEFA Program USAIDMadagascar

Health care in rural Africa is compromised by distance and accessibility. As we saw several years ago in Sierra Leone, the Ebola outbreak spread quickly in remote areas in part due to misunderstandings about the disease, treatment, and how it spread.

Communicating information and delivering basic health related supplies, some as simple as soap, are huge first steps in battling disease and even death in  small rural communities.

Our partner in Madagascar is focused on providing health services across six remote regions in north and northwest Madagascar. This program is known locally as MAHEFA, a USAID-funded project.

Over the course of the program 6,052 community health volunteers (CHVs) were trained, equipped, and supervised to provide basic health services in the areas of maternal, newborn, and child health; family panning and reproductive health, including sexually transmitted infections, water, sanitation, and hygiene; nutrition; and malaria treatment and prevention at the community level.

Community health volunteers play a critic role in providing health services, especially to women and children. CHVs provide antenatal care, deliver vaccines, teach about proper nutrition and sanitation practices, among other family planning services.

The biggest obstacle for these CHVs is reaching the families who depend on them for basic health services. The primary challenge identified through MAHEFA was one of transportation.

Almost half of the villages in this region are inaccessible by motor vehicle for at least four months of the year due to the rainy season. One fifth are inaccessible for nearly half the year, placing residents at risk. While public transportation does exist for some areas, at some times of the year, it is frequently insufficient, unreliable, and/or expensive. As their title suggests, CHVs work on a voluntary basis and therefore receive no compensation to offset travel expenses.

The solution: bikes. MAHEFA provided 1,020 new bikes to select CHVs in 220 communes. They also received training in safe riding, management, maintenance, and repair of bicycles.

The effort to supply bikes was to solve several issues in providing care in these remote areas. Assisting CHVs in transportation to patients, medical supplies, and support meetings were key aspects of the program. Additionally, providing an incentive to CHVs, working long hours for free, was also a priority.

CHVs reported being able to visit patients more frequently and also further distances away, while still saving themselves time and energy. The cost of transportation also dropped significantly. Whereas before CHVs would hire a taxi or ox cart they could now ride a bicycle for free.

An unintended response came from patients who ended up respecting caregivers arriving on bicycle more than those on foot. In Menabe women perceived that CHVs who arrived at their homes on bicycle were providing services of higher value. The social status of CHVs soared just by owning a bicycle. This also increased the CHVs motivation level to perform their jobs.

Menabe eBox

Several challenges still existed. Only 17% of CHVs received bikes through this program. Of those, many still struggled to maintain their bikes due to the availability of spare parts and even service. While all CHVs received training and tools to work on their bikes, some of the more complex repairs were still out of reach.

MAHEFA identified four of these regions in which to place accessible bike shops, called eBoxes. An eBox is often staffed by CHVs, providing an even greater incentive by offering a salary to those employees. Used bikes donated from the UK and USA (Bikes for the World) were delivered to these eBoxes along with a supply of used parts.

These micro enterprises assist CHVs with parts and repairs of their bicycles. The shipments of used bikes from overseas also help fund the shops as well as contribute to the health related activities of the communes. Bikes for the World sent its second shipment of bikes to this project just last week.

Sustaining Health Care In Madagascar

From Arnaud Flickr

Madagascar, the fourth largest island in the world, is also one of the world's poorest countries. 80% of the population lives in rural areas with difficult access to most services. In Madagascar, as in many other countries, the remote communities living in poverty are the most vulnerable segment of society. The availability of health services is extremely limited, leading to high rates of infant, child, and maternal mortality. In addition, 65% of the population does not have access to safe drinking water and sanitation.

The USAID-funded Madagascar Community-Based Integrated Health Project known locally as MAHEFA is focused on providing basic, quality health care to isolated populations in six north and northwestern regions of Madagascar (DIANA, SAVA, Sofia, Menabe, Boeny and Melaky). This project's funding ended last year, however, a new grant was just awarded to continue and expand the important work in Madagascar.

The program’s vision is for thriving families and communities to access sustained, high-quality health services at the community and facility levels that are responsive to client needs and interlinked through excellent health system and community management. To achieve this, the program will increase access to and use of key services, and improve regional, district, and commune management and systems in the seven regions identified in the program.

A need for an emergency transport system was identified and tailored solutions to fit the needs of patients in these areas were defined, developed, and implemented through MAHEFA. Community Health Volunteers (CHV) were evaluated and challenges noted. MAHEFA brought new bikes into the program that were delivered to certain CHVs in greatest need of transportation.

Antsohihy Co-op

In an effort to provide monetary incentive and technical support to these health volunteers, MAHEFA also established four eBoxes, which would serve as small rural bike shops. Some CHVs and other community members were trained to fix bikes and operate the small bike businesses.

Bikes for the World donated several containers of bikes and spare parts to this project over the last year. Bikes are fixed up by MAHEFA trained mechanics and sold to local families who use them for school and work. Many farmers are buying and using bikes to help tend to their crops and carry produce to market.

The profits from the bike sales and repairs are being used to support health initiatives in these small rural communities. The co-ops benefit from paid dividends, employees receive a small salary for work in the shop, and other revenue helps support the Emergency Transport System and health insurance in the community.

Contributors, JSI and Transaid

Le-makesusproudtobeamerican-Decky

Katie with Team USA from Instagram

Oh Now you've heard of Katie Ledecky? And you've likely now heard us mention she volunteered at Bikes for the World for two years with Stone Ridge's Social Action Program. So what's she really like?

Exactly what you see. Katie brought to Bikes for the World exactly what she brought to the Olympics. She was dedicated, a hard worker, and a team player.

There are really three things we heard during the Olympics that stuck with us. #1 Katie told us all to enjoy the journey. This is something we saw in our warehouse every other week not just with Katie but the entire Stone Ridge crew.

Ken with Yvette

And it really started with this guy, advisor Ken Woodard. Ken brings his passion for bikes with him every time he steps into the warehouse. And that trickles down to his students. When we started working with Stone Ridge back in 2011 we had two volunteers from the school. As we excitedly await their return this September, that number has risen to 10, and many of them return from their junior to senior years.

Katie had this to say about working with Mr. Woodard: "He is a wonderful role model for all of us as his dedication and his willingness to help others is so evident. He demonstrates how important it is to help others, and how much fun can result from doing so."

Katie's first day at King Farm

#2 We heard throughout her 800 Free how Katie Ledecky was making that race cool again. Many moms were reporting that their little girls were watching Katie swim and wanted to be just like her. Long distance swimming was becoming popular thanks to Katie's success in the event. Her overall personality made her a much loved role model to, well, everyone!

And over the past three years this is exactly what Katie brought to our program. Honestly, all of Stone Ridge, each of these volunteers made an Impact. Stone Ridge took over our warehouse twice a month and spent most of their time working in the back with chain breakers, frame taps, bottom bracket tools, crank pullers...pulling parts off bikes many of us didn't even know came off!

Troop 1999

And our young volunteers were watching. During the last three years Bikes for the World partnered up with more Girl Scout Troops than ever before. They saw what these women of Stone Ridge were accomplishing and they wanted to be just like them. Putting tools in the hands of these capable young girls brought more confidence to many of them and we credit much of that to all our Stone Ridge volunteers.

Kaite with her Social Action Team

#3, finally, almost every interview with Katie Ledecky poolside ended with Katie saying into the camera, "Go USA!" Over and over sitting in our living rooms we sat watching Katie swim. Just Katie, because the camera couldn't capture the entire field, that's just how fast she is. Commentators said things like, "Katie is in the pool by herself" and "Katie is racing herself".

Katie Ledecky never once forgot Team USA. And she never once put herself ahead of anyone else in the Social Action program. Katie was just another student in our warehouse. When we met her she already had one Olympic Gold medal and she went on to break world records the entire time she was with us. But in our warehouse she joined her friends and teammates, pulling pedals off bikes and wheeling bikes on trailers.

Rolling bikes for the Philippines

During her last day with Bikes for the World she helped load the container of bikes that ended up in our Bikes for Education project in the Philippines. When Bikes for the Philippines found out, they were thrilled.  " Thank you Katie and Race on for the Gold. From us here in the Philippines. Mabuhay!" 

Likewise, Wheels of Africa in Kenya sent this message before the Olympics, "We look forward to watching Katie Ledecky as she competes in the Olympics. We wish her all the best." Katie not only brought together the USA, but the whole world took notice and cheered her on.

Congratulations Katie and thank you for your service. Welcome home. We can't help but think of everything Katie has brought to Bikes for the World and wonder how much of that Stone Ridge brought to her initially. Katie Ledecky, hands covered in grease, and a heart of gold.

Yo Amo Chepe

Las calles no son solo para los carros... hoy las calles de Tres Ríos se llenaron de cletas!

This past Sunday cyclists took over the streets of San Jose, Costa Rica. By the hundreds. To bring awareness to this growing popular past time.

Cycling is undergoing a transformation in Costa Rica, especially downtown. More people are recognizing it as a relaxing, healthy activity to be enjoyed, not just a means of transportation for the poor.

Luis (FINCA CR), Keith, Yvette, and Kaila (BfW), and Roberto (Chepecletas)

When Bikes for the World visited Costa Rica in 2014, we met with the Director of Costa Rica's popular bike advocacy group Chepecletas based in the center of bustling San Jose.

Roberto Guzman is championing for 'Cletas' to make the roads safer by increasing the number of bikes on city streets.

Chepecletas works like our beloved WABA here in the DC area. They sponsor group rides, preach about safety for cyclist to cyclists, motorists, and to government officials, and work to bring better cycling conditions and laws to the city.

BfW touring San Jose via bicicleta

Guzman studies infrastructure around the world. He looks at what works and what doesn't and he tries to introduce that around Costa Rica.

Says Guzman, "Biking is not just for poor people, it's for everyone," something Chepecletas hopes to change about attitudes toward cycling. And by the look of Sunday's ride, it's working.

It's not uncommon to see laborers using bikes for work, to haul heavy loads or ferry produce to market. Day laborers commute into the city daily for work. Moms and kids use bikes for errands and to get to school. And for the most part, the roads are safe in these rural communities. Traffic is calm and there aren't many cars.

But Costa Rica is starting to seeing health enthusiasts grab a bike and roll. And nothing makes Guzman happier.

And nothing makes the work of Chepecletas more important. Guzman's passion is to get more people on bikes; his mission is to make the roads safer for them. Costa Rica has been slowly adding ciclovias to the city infrastructure. Ciclovias make up a network of bikeways that web throughout the city. Right now they are short and scattered, but popular and well used.

Bikes for the World donates thousands of bikes to Costa Rica through FINCA Costa Rica's MiBici program. Most of our 24,000 plus bikes donated over the years have been spread across the country in small communities that need bikes for their livelihood.

We also support Chepecletas and are proud to be part of their advocacy work. For anyone needing a bike during a group ride, Chepecletas may be loaning out YOUR old road bike or three speed. And they require helmets on their rides, day or night.

Changing Gears in Nairobi

CESTA in El Salvador

Yesterday we brought you the story of how Bikes for the World partner CESTA is bringing change to El Salvador through bikes. By promoting the environment, bikes, and safer infrastructure and laws CESTA is working toward making cycling a preferred method of transportation in the country.

This is not the only BfW partner to focus on putting more people on bikes! ALL people. Wheels of Africa, (WOA) based in Nairobi Kenya, has similar motives to bring more bikes to the streets and more safety and awareness to the community. In fact, Wheels of Africa states in its mission they, champion for cycling as a sustainable means of transport and source of livelihood. 

Patrick and Geoffrey of Wheels of Africa

Wheels of Africa has received over 7,000 bikes donated by Bikes for the World over the past five years. Many of those bikes are sold in small bunches to local bike repairmen who work on the bikes and sell them in small communities where bike services are not readily available. This allows the small staff at WOA to reach a greater number of beneficiaries while still remaining focused on their goal, getting more people on bikes.

A big challenge for WOA in their quest for increasing cyclists has been overcoming the stigma associated with riding a bike in Kenya. For many years a bike has been a symbol of the poor. Through organizations like WOA, cycling has reached a greater population of both poor and rich. Riding a bike is quickly becoming a popular activity in Nairobi and WOA is proud to be part of that transformation.

Through programs like their Weekend Adventure Rides and participation in World Kidney Day, WOA is creating a platform to promote cycling in Nairobi and finding it to be quite popular among a wide range of riders. WOA offers both beginner and more advanced rides in urban and and mountainous settings. And they focus on things like safety on the road, on the bike, and highlight the area's new cycling lanes. The main objective in addition to helping riders gain more confidence on their bikes and the roads is TO HAVE FUN. 

What was once seen as 'a poor man's way of life' is quickly becoming the latest fitness craze on the streets of Nairobi. WOA is seeing an increased demand for higher quality bikes, used jerseys, and interest to join their sponsored rides. WOA takes the time to train new riders and plan rides for both new and experienced riders. Some riders just need more experience (and confidence) riding on busy, narrow streets in town. Some are looking for safari riding partners to tackle the muddy Ngong Hills trails. Bottom line: Wheels of Africa has something for everyone!

No Bike No Planet

Courtesy Ciudad Mujer

By sending bikes into remote areas and even crowded city streets around the world, we solve one problem of transportation but create yet another challenge. Many areas where our donated bikes end up lack the infrastructure to support wide bike use.

Many of our donors and supporters recognize the immediate need for helmets to keep riders safe, but often overlook the need for safety and maintenance classes for new bicycle owners.

Not only does our Salvadoran partner CESTA appreciate the value of training new bike owners, encouraging them to ride safer and keep their bikes in perfect working order, but they see the bigger picture too. CESTA also knows the value of bringing safer streets to the neighborhoods where these bikers live.

This spring CESTA launched a national campaign called No Bike No Planet which aims to raise awareness and sensitize the population about the importance of cycling as a means of transportation in the country. CESTA is an environmentally based organization that is focused on protecting the Earth and empowering people to live greener lifestyles. A bicycle is an important tool to their mission.

The No Bike No Planet campaign leaves no stone unturned. CESTA, working within the community, is hosting forums unveiling the impacts of climate change and stressing the importance of the bicycle to counteract global warming. Their message: 'a bike is a valuable transportation solution that helps reduce environmental pollution.' The campaign is committed to reducing air pollution in the capital of San Salvador where the health of residents is impacted. CESTA is bringing this conversation to several communities and forcing it into the media where it will reach an even greater number of people. 

CESTA signed an agreement with the Ministry of Public Works to work together to bring affordable, eco-friendly transportation to the country. In order to promote this means of transportation, both sides realize an effort to keep cyclists safe on the roads is in order. They are working to bring more cycle lanes to busy, crowded roads, more respect among drivers, and incorporating bike use in driver education.

For cyclists, CESTA is working within the school system to introduce bike use to students. They are hosting many workshops around the country that will focus on bicycle repair in hopes that some graduates will take this new skill to create repair shops in their communities. In addition to promoting cycling, this model would also generate employment in mechanics and business.

CESTA brings their message to students at grade schools and universities. With an education platform, bike use is pushed as a sustainable solution to keeping our planet clean and healthy. CESTA trained mechanics show students how to change a flat tire, grease a chain, or do minor bike repairs. In some schools, CESTA has also hosted large group rides to help spread the bike word.

Featured Volunteer: Taylor Maher

This month we recognize volunteer utility player Taylor Maher. Even before the spring collection season began Bikes for the World insiders sat down in a meeting and decided, we need help.

As we increased bike pick ups at condos, police departments, universities and recycling centers...our bike shop partners were also upping the ante by collecting even more bikes every week than in previous years. Looking over the planned spring calendar of community led collection events on the weekends, we knew we needed another driver. So we put out the call to hire a part time driver.

Taylor not only stepped up to fill that role, but he said, hold the check. Taylor had a personal connection to Director Keith Oberg and wanted to help out Bikes for the World. As Taylor continued to look for employment, he planned to help us pick up bikes whenever his schedule allowed.

When Taylor joined the team we had no idea how important he would become over the next few months. He started by just picking up bikes at bike shops to give Operations Manager Taylor Jones time to catch up on paperwork in the office. That quickly morphed into helping on the weekends when our collection schedule often called for two or even three drivers in one day.

Then we got the word that Phil Ruth, dedicated long-time volunteer and driver was moving back west to be with family. And Taylor Jones resigned. YIKES! Keith found himself thrown back into the container loading several shipments in one month, while picking up bikes at shops and recycling centers, and oh, while still maintaining his duties as executive director. Taylor Maher was only supposed to be with us through maybe May...and as of last week was still out collecting bikes, picking up while Keith enjoyed a little R and R on vacation.

We were incredibly lucky to have Taylor join us to lend a hand this spring and summer. He stepped up to mentor young students at school collections, loaded and unloaded bikes and of course drove through nasty DC traffic, even as Metro unveiled 'Safe Tracking'.

Taylor even dropped by the warehouse unannounced a few weeks ago to give Keith a hand loading some third levels in the container during a particularly hot DC week.

Our hats off to Taylor for his generosity and help. When some organization does snatch him up we sure will miss him around the warehouse and collection sites! Thank you Taylor!