Health workers ride through the country’s rugged terrain to collect medical samples from remote villages—with the help of new technology.

Riders for Health

Nestled inside South Africa is Lesotho, a small mountainous country of just 2 million. The landscape there is harsh; there are some roads built within the capital city of Maseru, but little signs of road infrastructure anywhere else. Many public health services, like hospitals and labs, are in the city—yet most people live in villages scattered throughout the rugged terrain.

Just getting to the nearest health clinic can take villagers hours. And that’s a problem for a country with one of the highest rates of HIV and tuberculosis. Transporting patient records and blood samples between remote clinics and the labs located in the city is a long, rocky journey. That means the time it takes for a patient to get his or her lab results back and start necessary treatment is often delayed.

“We have very cold winters between May and end of July, and we have snow making it very difficult to get to places,” Mahali Hlasa, who lives in Lesotho, tells CityLab.

But where cars and trucks can’t reach, motorcycles—a common mode of transport throughout rural Africa—have zoomed in. Hlasa is Lesotho’s country director for an organization called Riders for Health, which began training and employing health workers on motorcycles there in 1991. She herself was among the first to become a trained rider, and later, she became the organization’s first woman trainer.

The 72 riders currently working with Hlasa are responsible for transporting specimens between the clinics and labs, and since 2014, they’ve also been working with UNICEF and Lesotho’s ministry of health to deliver immunization services. The riders visit more than a dozen clinics a week, setting out at 9 a.m. to pick up samples. It can take them more than two hours to get the samples back to the labs, and depending on how far out the clinic is, Hlasa says some riders don’t return until late afternoon.

Even so, the organization touts that it takes an average of a week for a patient to get his or her test results back from the labs. Before the riders came along, the entire process took twice as long.

The program isn’t without its road blocks, though. Rain and snow can stop riders carrying samples in their tracks. And some pathways aren’t accessible, even by motorbike. “I heard [the riders] describing a particular district where they serve two facilities across the river, [and] there was no bridge,” Sean Herman, a graduate student at the Jacobs Institute at Cornell Tech who was recently in Lesotho to do research, tells CityLab. “They had to drop the sample on one side, and sometime later in the week, a guy with a boat picks up those samples and puts them on a box on the other side.”

Information on the thousands of samples collected by motorcyclists is recorded on paper. (Sean Herman)

Thousands of samples are transported every month, and riders currently record all their information on paper. That means it’s easy for samples to get mixed up or miscategorized—especially on delayed trips. In the worst-case scenarios, specimens are given to the wrong labs, and vital test results never make it back to the patients.

But Herman and his team at Cornell Tech, led information scientist Nicola Dell, have developed a mobile app aimed at helping health workers digitally track the samples. Each group of samples is assigned a barcode, which  makes it possible to track information including what clinic it came from and what tests are needed. At every stage of the transport process, the information gets updated. When riders scan the code with their phones, the stats are uploaded onto a web server that will help Riders for Health monitor the workflow.

The team is preparing to launch a pilot program with a few of the riders before handing it off the to Lesotho’s ministry of health for a nationwide rollout. When it finally is in place, Herman says, they should be able to see where the bottlenecks are in the transport process. “The hope is that by understanding where the delays are, they can improve turnaround times.”

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