In 2015, Riders entered in Liberia by government of Liberia’s invitation, through the Ministry of Health, to setup a national sample transport system to help improve patient’s diagnosis by reducing time of case interventions through rapid specimen diagnostics. On the 4th of March 2015, Riders signed a tripartite agreement with the Ministry of Health (MoH) and the General Services Agency (GSA) for vehicle fleet management in Liberia marking the birth of a new program and the very first Ebola sample pick up by Riders’ couriers were by the second week of April the same year, making it the fastest implementation ever.
One major challenge the Government of Liberia (GoL) needed to solve was to get specimens rapidly and safely for suspected EVD cases from across the 15 counties to the laboratory for testing hence, Riders for Health Liberia (RFHL) Specimens Transport Network was setup on the premise of carrying EVD specimens including dead body swabs from all major health facilities, ETUs, CCC and funeral homes across the 15 counties of Liberia, taking them to where there is testing capacity. The testing capacity was ever changing from a total of 15 EVD testing centres including temporary labs dotted around the country in 2014 to 9 in 2015 as the Ebola incidence reduced. In 2016 only 4 EVD labs remained until the EVD lab at ELWA was finally decommissioned in 2017 when the EVD incidence got to zero, thus leaving 3 labs with testing capacity which included the lab at Phebe, Tappita and the National Reference Laboratory (NRL) in Margibi County. Coping with all the changes shows the robustness and flexibility of the Riders for Health Liberia (RFHL) Specimens Transport Network system.
At the height of the Ebola surveillance from 2015 to 2016, Riders for Health Liberia (RFHL) also managed Ministry of Health Liberia ’s national fleet with a total count of 534 vehicles for Liberia’s health system, composed of 281 motor vehicles including ambulances and trekking vehicles, 183 motorcycles, and 70 Sample courier motorcycles.
The ambulance support system includes emergency driver training, fuelling and fuel management, vehicle maintenance, and parts supply chain and accountability activities. The system has the capability of generating reports for real time tracking of patients and disease or reason for patient’s referral, referral distance (kilometres travelled) and ambulance location.
Riders for Health Liberia (RFHL) built capacity in both infrastructure and human capital. A total of (6) six maintenance garages (hubs) were constructed across Liberia and over 404 Liberians all Ministry of Health (MoH) employees were trained and assigned to work as managers, technicians, drivers and sample transport couriers- to handle biohazardous materials, to suppress Ebola. Fifty-eight (58) technicians from Ministry of Health (MoH) and GSA were trained and on road safety alone a total of 666 drivers/motorcycle riders (356 drivers and 311 motorcycle riders) were trained in advanced driving/riding and basic preventive maintenance during implementation.
Organizational Management Capacity
To efficiently manage the complexity of the program it is necessary to have sufficiently qualified staff no matter where they come from, with close oversight and management by Riders international management & technical experts, this, creates a unique south-to-south learning opportunity, which is a relatively unique aspect of Riders’ work). This principle creates local employment and expertise at all levels of the system.
There are five (5) International staff assigned to the project. Executive Director/Project Director who is based in the United Kingdom leads the planning and designing of Sample transport in Liberia. He leads the program in strategy, project development and innovations and overview supervision. The Sample Transport Specialist who is the Business Official, has on the ground overview of the system, from the financial systems and operational systems. The Replication Director works on systems and processes on finance, supply chain and M & E. The Technical Director works on fleet maintenance operational systems, building technical capacity for the technical team who do servicing and monitoring of motorcycles and vehicles for the project. Communications & ICT is a computer systems expert who works with the Executive/Project Director on technological solutions and improvements (e.g., Internet of Things IoT), takes care of all communications on websites and social media and works with the M&E team to consolidate all the project systems’ data as needed.
The Local Liberia Team is led by the Country Director/Project Manager who directly manages the ST Finance and Administration Manager, the Operations Manager, the Workshop Manager, as well as the Monitoring and Evaluation (M&E) Manager and Supply Chain Manager. Each of these business unit managers has smaller teams of staff to support their goals and activities.
The breakdown of 84 local staff members: Finance and Admin department including its manager is a six (6) member team, to include the Human Resources Coordinator. The M&E is a team of three (3) including the Manager, their role is to monitor performance and to measure and evaluate the Riders Liberia impact, and provide information to stakeholders. The Supply Chain department including the manager is a team of three (3) looking at goods procurement, locally and internationally. The Operations and Technical department are the biggest one headed by the Operations Manager supported by the Technical Manager. There are 60 ST couriers, including five (5) head couriers, who carry samples from the peripheral areas to the laboratories. The couriers make up the largest proportion of the ST team. And the five technicians that service and maintain the 60 motorcycles used by the ST system, six (6) motor vehicles and 51 sample storage fridges and freezers distributed across the country.
Operational, & Financial capacity
The program has managed multimillion dollar grants over the six-year period from 2015-2021. It is audited by independent auditors every year. Audit reports can be shared with potential partners on request.
The national sample transport system uses 60 couriers picking up specimens from 394 pick-up points, connecting all health centres to the laboratories in Liberia in partnership with the Ministry of Health and the National Public Health Institute of Liberia supported by US CDC. During the time of the Ebola outbreak (2014-2016) Riders Liberia transported an average of 3,500 samples while it reached a peak of 5,053 samples/month during the heightened Ebola surveillance. From April 2015 to June 2021 a total of 132,282 samples were transported and out of these a total of 78,349 were COVID-19 samples transported from March 2020 to June 2021. A total of 6,117,613 km has been covered from April 2015 to June 2021 for transporting samples. In June 2021 more than 10,000 specimens were transported, 92% were specimens for COVID-19 investigations with the remainder being IDSR specimens (specimens for Liberia designated diseases of outbreak potential, including but not limited to meningococcal disease, Lassa fever, yellow fever, shigellosis, measles and many more). Before Riders only 25% of samples reached laboratory in 24hrs and after Riders Liberia intervention that has now drastically improved to 98% of the samples reaching within 24hrs. From 2016 to 2021, a total of 549 participants attended refresher training as part of Liberian team capacity building, and to MoH, for continuous improvement and standardized Sample Transport systems and processes.
• In Liberia, Riders for Health Liberia is currently being funded by US Centers for Disease Control and Prevention (CDC). During Ebola it received funding from the U.S. Agency for International Development Office of U.S. Foreign Disaster Assistance (USAID/OFDA) via the World Health Organization (WHO, CDC Foundation.
• The Liberian Government and the World Bank through the World Health Organization provided direct financial support to the Riders for Health Liberia (RFHL) for the Fleet Management project.
• Through the funding received, Riders has invested in health transportation infrastructure building including human capital development, garages and sub-offices construction as well as system development and standardization for a reliable health transportation system for the Liberia health sector
Riders for Health Liberia (RFHL) is open to partnerships and flexible and versatile for example:
• It impacted on the successful implementation of the 2019-20 Liberia Demographic Health Survey (LDHS) by the Liberia Institute of Statistics and Geo-Information Services (LISGIS), supported by CDC, where the system transported samples for Hepatitis B and C, Ebola Virus Disease (EVD) antibodies, and HIV for testing at the national reference laboratory within the specified period and in the process upholding and preserving specimen’s laboratory viability for quality test results.
• Partners with Africa Field Epidemiology Network (AFENET) for the Surveillance for Acute Febrile Illness (AFI)
• Is a member of the Incident Management System (IMS) headed and coordinated by the Minister of Health (MoH) National Public health Institute of Liberia (NPHIL) and) constituted by all health partners in Liberia
• Open to partnerships and flexible and versatile, it also impacted on the successful implementation of the 2019-20 Liberia Demographic Health Survey (LDHS) by the Liberia Institute of Statistics and Geo-Information Services (LISGIS), supported by CDC, where the system transported samples for Hepatitis B and C, Ebola Virus Disease (EVD) antibodies, and HIV for testing at the national reference laboratory within the specified period and in the process upholding and preserving specimen’s laboratory viability for quality test results.