The eBox Beginning: From Namibia to Madagascar

Michael Linke (back) with the crew at Walvis Bay

So where did this Malagasy idea of an 'eBox' come from? None other than BfW partner BEN Namibia (BENN) and founder Michael Linke. In fact it's BENN's model and training that made the bike enterprise 'box' come to life in Madagascar through overseeing partner Transaid.

After Transaid identified the need for a motivating, sustainable project to compliment the health initiatives in Menabe, the idea of bikes and repair was a natural fit. And they looked to BENN, who has been running successful bike co-op shops for nearly a decade, for guidance.

TKMOAMS eBox crew with Michael Linke and Madagascar visitors

Two years ago these minds got together and laid out a plan to bring the eBox idea to Madagascar. Michael visited Madagascar and key players from the MAHEFA program in Madagascar paid BENN a visit to see the eBox in action.

Together, these two groups created the Malagasy eBox system, which looked a whole lot like BENN's eBox genius. BfW was quick to jump on board to help support the effort in Madagascar knowing first hand the success in Namibia.

BENN established their first official eBox (known then as a BEC, Bicycle Empowerment Centre) in December of 2006.  This is also the first year BfW and BENN joined forces. Since then, BfW has donated nearly 2,000 bikes to Namibia in support of this program.

Gloria rides by local eBox

An eBox is a shipping container filled with about 350 bikes, spare parts, and tools which BENN delivers and positions in rural communities around Namibia. They are run as small businesses that often times become the hub of the community.

In addition to the tangible components of a bike shop, BENN also provides training to new mechanics and business skills essential to running a successful business.

What began as solely a 'bike business' has grown into much more over the last decade. Many of the established eBoxes provide funding to other organizations and community run efforts through income from bike sales. The eBoxes are supporting health care workers, feeding children, and providing jobs and transportation in areas where cars are scarce.

Solar power station. Photo: Elephant Energy

And it's no longer just about the bike. Elephant Energy introduced the idea of the powerful FREE solar service to communities around Namibia. EBoxes now also sell solar powered devices and travel around promoting the idea of using the sun to power items like lights and even cell phones.

Through other partnerships, like Elephant Energy, eBoxes now supply a range of goods and services to the community, outside of 'just bikes'. This prompted BENN to change the name of these entrepreneurial shops from BECs, less emphasis on just BICYCLES, to eBoxes, more emphasis on ENTERPRISE and growth.

Miandrivazo container shipped thru BfW

Back to Madagascar. In 2015, BfW sent the shipping container seen in this photo (left) to the co-op eBox known as Miandrivazo. The container was packed with bikes, tools, and spare parts to help get this co-op off the ground and rolling. Just this month a second container arrived in Madagascar from BfW.

And, as in Namibia, this newly formed bike business is already doing more than just selling bikes. It's creating jobs, incentives for health workers, and even planting the seed (pun intended) for new business ideas. Plans are already in the works for this community to start diversified businesses ranging from selling rice, fish, and vegetables.

Miandrivazo eBox: Making Our Bikes Work

To us, this looks like the inside of an average shipping container. Bikes for the World loads and ships about 30 of these a year. They are packed with about 500 donated bicycles, each one of those affecting and changing up to four lives each.

But this particular container is different. This container was loaded in the spring of 2015 and arrived in Madagascar several months later. It contained over 500 bikes and tons of spare parts. But that's not all, the container itself would remain behind and become a workable, viable bike shop!

Jump over to Madagascar, and here's what that 'idea' would look like. This shipping container arrived packed with bikes which became the 'stock' for this newly formed micro-business.

The container is placed in a rural location to better serve new bike owners who may need parts or service in the future. Rather than traveling many miles to a city, where such services are available, this community run shop will help keep these donated bikes rolling while also creating local jobs in town.

The container is modified to better function as a bike shop. Maybe they add windows and doors. Another roof to help block the heat of the sun. It really becomes the bones of the business. And the heart of the community.

This concept is known locally in Madagascar as an eBox. It was more than 'borrowed' from BfW's Namibian partner Bicycle Empowerment Network (BENN); BENN helped establish and train participants in this pilot effort. Trainees learned about bike sales, repairs, and how to effectively run a business. Maintaining this project as a sustainable business is a top priority.

Ultimately, four cooperative bike shops were established in Madagascar through this recent effort. The container above, which shipped from Arlington VA, is currently being remodeled to become a lasting part of the shop, seen here, in Miandrivazo.

Our second container of donated bikes, which shipped in August, is set to arrive in Miandrivazo later this month. The success of the project relies on the new skills brought into the co-op and the arrival of a second shipment is testament that it is working.

Earlier in our blog we explained the importance of the eBox and how revenue generated through bike sales is helping not only the community but also the entire health care initiative established through Transaid.

Mr. Joceyln is a peer educator and now bike mechanic. Mr. Joceyln is a volunteer who travels around spreading valuable healthcare information to people in his village. This important knowledge is helping save lives and keeping people safe.

To help Mr.. Joceyln travel long distances to reach more people, he received this brand new Spida bike through the MAHEFA project.  Mr. Joceyln was chosen to receive training as a bike mechanic as a means to offer an incentive for being a volunteer. He now also works as a mechanic and receives a small salary which helps support his family.

Mr. Joceyln will be on hand when our bikes arrive in Miandrivazo, and he will ensure that those bikes are in good working order before they are distributed throughout the region. 

Introducing the Malagasy eBox

In 2015 Bikes for the World arranged to ship two containers of used bicycles and parts to Madagascar through the USAID funded MAHEFA program. This project focused on bringing affordable health care to northern and western Madagascar.  Several challenges were identified as the program evolved, each defined, studied, and addressed through MAHEFA.

Distance was by far (no pun intended) the most encompassing challenge. MAHEFA developed solutions to this issue from several angles to ensure life saving health care could reach the most rural families.

Community Health Volunteers (CHV) provide an essential role in the delivery of health services to residents in isolated and under-served areas of Madagascar. These health workers are recognized and approved by the government, although not paid for their services.

Through the effort of CHVs, patients living a great distance from their nearest health clinic were now receiving basic health care. These services included child health, family planning, STD treatment and prevention, hygiene and nutrition.

However, because CHVs are unpaid, MAHEFA encountered a high turnover rate which greatly affected the quality and continuance of care in these rural areas. MAHEFA identified the two top reasons CHVs quit were motivation and mobility.

MAHEFA then introduced bicycles to select CHVs to ease the burden of traveling to see patients. Over 1,000 new bikes were given to these volunteers to assist in delivering life saving practices to entire communities. CHVs arriving on bikes were even seen as more 'credible' or trustworthy because they had bikes.

This introduced a new issue, one of repairs. While CHVs also received training in basic bike maintenance they still lacked the necessary parts and more complex tools to do serious repairs on bikes. So MAHEFA introduced the eBox.

An eBox is a permanent bike shop established in areas where little to no bike services are offered. Community members (often CHVs themselves) were trained in mechanics and sales. This micro-enterprise, operated at the community level, would provide jobs and income and ultimately support the health initiative MAHEFA created.

Additionally, the four eBoxes established through MAHEFA, would also provide support to the Emergency Transport System (ETS) which had previously been implemented through this project. ETS is a multi-modal system of patient transport, basically a 'creative' (and effective) ambulance. One particular approach is a bicycle ambulance, which would also need routine bike maintenance and parts.

Through these donation-supplied bike shops, job are created, income generated, transportation provided, and services and parts readily available. EBoxes addressed the issues of motivation AND mobility. Most newly trained staff also report a sense of pride in their community through their new skills and this brand new venture.

Bikes for the World donated and shipped 1,000 bikes in two containers over the past year to support this effort. Additionally, we helped place another 450 bikes in this project through sister organization Working Bikes from Chicago. Both BfW packed containers, were donated directly to the co-op known as Miandrivazo in Menabe.

Saving Baby Mahazomaro

Robin Erinesy is helping to save lives in his community as part of the Emergency Transport Scheme (ETS) in Madagascar. He operates this bicycle ambulance to help deliver patients to medical professionals.

Transaid has been working in this area of Madagascar for 30 years now. They helped establish several means of emergency transport to bring rural residents to life saving health services. These include ox cart ambulances, hand carried litters, bicycle ambulances, and canoe ambulances. They have also equipped thousands of volunteer health workers with bicycles to help with transportation.

Because the roads are poorly maintained and the terrain is difficult to navigate by motor vehicle transportation is often expensive if accessible at all.

Robin Erinesy is very familiar with transportation issues in his community. This is one of the reasons he got involved in the ETS.

Ten years ago Robin fell gravely ill. His family called the hospital to request an ambulance. The hospital refused to send help.

They were able to flag down a passing car who transported Robin and two other family members to the hospital. That trip cost Robin's family $9. This was one month's salary for his family.

Robin recovered but he was very angry about the situation. "They demanded a lot of money to help someone who was very sick," said Robin. This is typical, given there is no other option; drivers can charge any amount they want.

Five years later Robin was operating a bicycle ambulance, "I do it to help my community."

Additionally, by being part of ETS, Robin and his family are automatically enrolled in the community health insurance system. He pays 10 cents a month and the insurance covers ambulance service free and reduced cost on medicines for his entire family.
 
Robin was called to transport a baby in distress. Mahazomaro was only 18 days old when he experienced trouble breathing. Robin transported him to the local clinic, but they were not equipped to treat him there.

Robin then took him to the hospital in the bicycle ambulance where they were able to treat and save baby Mahazomaro. Mom and Dad had given up hope, but thanks to Robin and his bicycle ambulance Mahazomaro is now healthy and doing well.

Transportation and Health Care Go Hand In Hand

In the MAHEFA regions of Madagascar there was often limited access to any type of affordable transportation. Many roads were poorly maintained and the terrain made motorized transport challenging. Regions exposed to months of rain are also inaccessible nearly one third of the year. This made preventive health care a challenge, not to mention urgent care.

In addition to introducing Community Health Volunteers (CHVs) to these rural communities, MAHEFA identified a greater need for emergency transport, ensuring that patients had access to treatments and care not always offered by smaller community clinics.

Several modes of transport were identified and introduced to help assist in urgent care needs. Bicycle ambulances, wheeled stretchers, canoe ambulances, and ox-carts were all placed within the communities. They were chosen according to the terrain and context.

Since implementing the multi-modal ambulances through MAHEFA, 253 drivers have been trained on emergency transport. 151 ambulances have been provided. 185,053 people now have access to emergency care through ETS.

Each emergency technician is responsible for the care and upkeep of their respective 'ambulance'. Identifying specific needs for bicycle ambulances, including bike parts and trained bike mechanics, MAHEFA sought to support the ETS on a more technical level.

EBoxes were established in four regions of Madagascar to help incentivize CHVs and also help physically support the ETS. The idea was to bring mechanics and spare parts closer to the ETS operation to help support and facilitate the use of these bike ambulances.

Through the sale of bikes at eBoxes, which received donated bikes from the UK and US, co-ops could help support the cost of the ETS as well as the bikes themselves. It was understood that each co-op would help fund the ETS and mutuelle (health insurance) through eBox profits. This synergy between community, ETS, mutuelle, and eBox was created in an effort to make this program sustainable.

Robin Erinesy operates his bike ambulance whenever called

Now, whenever care is needed, help is there. ETS makes transporting patients of every age and illness possible over any terrain or weather condition.

The mutuelle helps families afford transport, care, and medicines to help keep their families strong and healthy.

And the eBox is the micro-finance initiative behind the motivation and success of CHVs, ETS, and the mutuelle.

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