Many of the challenges that we face in improving health care in Africa are based on two fundamental issues: 

• How do we make sure that a limited number of health workers reach everyone in their catchment area regularly? 
• And when we find a health worker willing to work in a rural part of the country, how do we keep him or her there long enough to become a trusted part of that community?

If we solve the first, I believe that we will go a long way toward solving the second. If health workers have no way of reaching people, they cannot do the job they were trained to do. They quickly become demoralized, and they may want to move away. Maybe to a town or a city, or—even worse for the health system—abroad, wasting the country’s investment in their training.

I understand this challenge. In 1990 I was an environmental health technician in Lesotho. I was frustrated because I knew that there were lots of people who needed my help, but I had no reliable transportation and no way of reaching the people who lived in very isolated communities.

We should give equal focus to making sure that health workers can physically reach their patients.

Then, one day, my senior officer told me that I had been selected to be trained to ride a motorcycle by Riders for Health. That training transformed my work. I was able to reach people reliably, and predictably. And because our motorcycles were well-maintained and serviced each month, they never broke down. I was shown how to check my bike daily, how to ride safely, and to how keep it running smoothly. And each month a technician carried out a full service. This is very straightforward, but so often health workers are given motorcycles and there is no system to keep the bikes running. So they break down, or they become dangerous.

When Riders for Health returned to Lesotho in 2008, cofounder Barry Coleman asked me to join as the program’s director.  Now we have 70 motorcycles that are used by outreach health workers to help provide health care in rural and hard-to-reach places. Counsellors provide support for patients with tuberculosis and HIV and make sure they take their medication. Others make sure clients have access to clean water. We also have 30 motorcycles that are used by a team of couriers to transport medical samples from isolated villages to clinics so the samples can be tested quickly and accurately. This is a system that we developed in Lesotho and now it is being replicated in Zimbabwe, Zambia, and Malawi. In September, our sample courier program won the Big Impact award at the Third Sector Excellence Awards in the UK. The transport needs in each country are unique. But in seven countries across Africa we have shown that improving transport increases the number of people that health workers can reach, and doubles the time they spend with communities. People living in rural villages often tell us that they feel a closer connection to their health workers because they have more time to spend with them, and the services are more predictable and reliable.

Whenever we talk about how to improve working conditions for health workers and how to better retain them, we often focus on pay and training a larger workforce. These are very important, but we should give equal focus to making sure that health workers can physically reach their patients. This is surely the first step to making health workers feel valued and increasing their productivity, by providing them tools that strengthen their role as the foundation of the health system.