#1363 1996 · Riders for Health · Healthcare logistics
Riders for Health sold African health ministries uptime — a flat fee per kilometre, breakdowns included
the problem
Donated health-ministry vehicles died young for lack of maintenance, stranding outreach exactly where roads were worst
background
Across rural Africa, health systems kept receiving vehicles and kept losing them: motorcycles and ambulances donated with no maintenance system behind them ran until the first neglected fault killed them — often within a couple of years in bush conditions. Health workers reverted to walking, drugs and samples stopped moving, and the next donation restarted the same cycle. The waste hid in plain sight because everyone budgeted for vehicles and nobody budgeted for the boring thing that keeps vehicles alive.
Andrea and Barry Coleman came from motorcycle racing, where machines survive brutal use through one discipline: scheduled preventive maintenance. Their reading of the problem was that ministries shouldn't be managing fleets at all — they should be buying transport as a service, the way a race team buys reliability.
what everyone would do
Donate more and better vehicles, attach a spare-parts grant, run maintenance training workshops for ministry staff. Every element leaves fleet upkeep inside institutions that structurally cannot budget for it — and the vehicles keep dying on schedule, which is why decades of exactly this kept failing.
what they saw
Ministries were being given the one thing they couldn't keep alive — assets — when what health outreach needed was a guarantee of motion. Selling kilometres with breakdowns included moves the maintenance incentive to the party who profits from prevention.
the move
Riders for Health contracted with ministries of health to keep their fleets running for a fixed price per kilometre (about 18 cents for a motorcycle, fuel included): Riders hires and trains local technicians, runs scheduled preventive service on every vehicle — replacing parts on interval, before failure — and the ministry simply pays for kilometres of working transport. The flat rate converts an unbudgetable stream of breakdowns into a predictable line item, and puts the incentive where it belongs: under a fixed fee, every breakdown is Riders' cost, so Riders' profit depends on maintenance actually happening. In The Gambia the model financed itself at national scale — a commercial bank funded the fleet purchase against the fee stream, with Skoll guaranteeing.
why it works
A fixed per-km fee inverts the economics of neglect: under ministry ownership, skipped maintenance saves today's budget and costs next year's fleet; under Riders' contract, skipped maintenance costs Riders directly, so preventive discipline is enforced by profit rather than exhortation. Racing-derived scheduled service keeps cost-per-km low and predictable in exactly the conditions that destroy ad-hoc fleets. And the contract's predictability compounds outward: ministries can budget transport like salaries, and banks can lend against the fee stream — asset finance in places grants could never reach.
the payoff
Fleets stopped dying: vehicles ran for years at full utilisation across seven countries, extending regular healthcare access to millions (Riders reports 14.5M people).
where it breaks
It fails when the customer's payment discipline collapses — a service contract with a government that stops paying strands the operator with a fleet and payroll (Riders itself was later wound down amid exactly such strains, though the model spread). It needs route density to keep technicians utilised, and it suits mechanical uptime; where failure modes are rare and catastrophic rather than wear-driven, per-use pricing buys less.
what came after
Proof that transport-as-a-service works for public health systems — the per-km uptime contract entered global health logistics practice, and the Colemans received the 2006 Skoll Award.
references
- [1]Fueling GrowthStanford Social Innovation Review, 2011ssir.org
- [2]The Surprising Link Between Motorcycles And Better African Health CareForbes, 2012forbes.com
- [3]Riders for HealthSkoll Foundation (funder profile), 2006skoll.org
Widely retold, only partly documented. Filed as hearsay.