Paul Matthew is providing prevention and treatment of sexually transmitted and other infectious diseases to mobile workers and related communities through roadside wellness centers and mobile clinics positioned strategically along major transport corridors in Africa.
The New Idea
HIV/AIDS prevention and treatment still remain a challenge for most countries, especially in sub-Saharan Africa, accounting for more than 71 percent of total AIDS-related deaths in the world. More susceptible to HIV and other sexually transmitted infections (STIs) are mobile workers, especially truck drivers and the communities they interact with as they travel on their routes. Paul has developed a mechanism to ensure that mobile workers and related communities get easy access to treatment and prevention measures for HIV/AIDS and other STIs. Through North Star Alliance (NSA), Paul puts mobile clinics, Roadside Wellness Centers (RWCs), in strategic places called “critical hotspots.” These are typically border posts, transit towns, and ports where large numbers of trucks stop and where sex work and other informal trades flourish, exposing both the truckers and the community to STIs and other infectious diseases.
RWCs are typically made from converted shipping containers designed to the standards of the World Health Organization (WHO). Although the wellness centers are designed to provide health services and programs for mobile workers and other related vulnerable groups such as sex workers, access to services is open to everyone in the communities nearby, to ensure an all-round holistic STI treatment and prevention program. Plans to provide male circumcision and laboratory services are currently in the pipeline.
NSA’s approach is unique in that it unites the transport and public health sectors in a common response to high impact diseases, working at the crossroads of disease and mobility to ensure that highly mobile populations and their direct/indirect contacts have access to basic health services. Paul envisions a world in which mobility and dynamic workplaces do not fuel the spread of disease, sexual abuse, and human trafficking. Today, NSA operates twenty-five wellness centers in twelve countries in East, West, and Southern Africa through which healthcare is provided to 200,000+ people each year. In the next three years, Paul plans to have 100 centers throughout Africa, reaching almost 85 percent of mobile workers, and hundreds of thousands of people in communities located along the continent’s main transport routes.
Sub-Saharan Africa continues to bear the devastating consequences of the HIV/AIDS pandemic which is impeding economic growth and social development in the region. WHO statistics indicate that in 2011 the region accounted for 69 percent of the population of people living with HIV and 71 percent of all AIDS-related deaths worldwide. Out of the 17.5 million children that have been orphaned by AIDS, more than 80 percent live in sub-Saharan Africa. The challenge to provide effective prevention and treatment measures for HIV/AIDS is compounded by exposure to other prevalent communicable diseases, such as malaria, tuberculosis, and numerous STIs.
Since the 1980s, public health experts have established that mobile workers (especially in sub-Saharan Africa), such as long distance truck drivers, are highly vulnerable and susceptible to STIs and other infectious diseases. AIDS has been reported as a number one killer among mobile workers, seconded by malaria and then road accidents. Long distance truck drivers in sub-Saharan Africa have an HIV infection rate which is almost twice as that of the general population. A study in 2001 by the South African
Medical Research Council indicated that 56 percent of all truck drivers tested in the country were HIV positive and one testing station actually recorded a 95 percent infection rate.
The high prevalence rate of HIV infections among long distance truckers is compounded by the nature of their jobs which forces them to stay overnight away from home. Separation from their regular sex partners and the established social routines and norms guiding their lives at home leads more easily to changes in their behavior. The truckers are exposed to long waiting periods at ports and border stations and also stop-over spots where they are exposed to commercial sex workers. A survey done by the International Organization for Migration in 2006 found that truckers reported different sexual networking patterns during their journeys and little or no use of condoms even though most of them were found with STIs. This puts the population of highly mobile individuals at a heightened risk of contracting HIV and other communicable diseases. However, mobile workers are not only susceptible to contracting these diseases but also play an important role in transmission. As a result, people in the communities around these hotspots are also at risk of contracting the infections.
The susceptibility of mobile populations to infection is further compounded by lack of access to quality healthcare services as they travel on duty. The available health services around the main routes are often not tailored to suit the specific needs and nature of their jobs. For instance, the healthcare facilities may be located far from the roads which may require the truckers to divert from their normal route to access the services. In other cases, operating time for the centers may not be convenient for the truckers as most of the facilities are closed in the evenings, making access to prevention, and treatment impossible. Thus the health systems in the region do not have the flexibility and infrastructure to conveniently reach out to mobile workers with services in treatment, prevention and counseling of HIV/AIDS and other STIs. There is an increasing threat that a generation of drivers in the transport sector will face death if interventions are not implemented in a strategic and structured way. However, despite this threat, transport companies and large supply chain operators have been very slow to respond. According to the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria the transport industry ranked last out of the 11 industries that participated in the survey, in their efforts to protect their employees against HIV and other infectious diseases.
This challenging scenario reached a point of public attention and first-time visibility when, in mid-2003, truck drivers were dying, their families were suffering and transport companies were struggling, yet there was no targeted HIV prevention or treatment available. Not only were commercial businesses affected by a dwindling driver pool, but humanitarian agencies found it difficult to hire enough drivers to deliver lifesaving commodities like food and emergency supplies. This was particularly critical for the UN World Food Program as they sought to move hundreds of thousands of metric tons of food during the height of the Southern Africa food crisis from 2003 to 2005. For the first time in memory, there simply weren’t enough healthy drivers to get the job done and that is when the urgency of the problem of mobile worker’s health was revealed to the public.
Paul was the first to challenge this problem by bringing together sectors that had no history of working in collaboration: transport, logistics, and health. Articulating the common interest of several actors in the field, especially the UN World Food Program and the large logistics company TNT, Paul created NSA, the first organization in Africa to offer a systemic solution fully tailored to the specific needs and challenges of mobile workers and the transport industry.
The success of Paul’s model is based on the flexibility and simplicity of how the RWCs are actually set up. The local team does research to identify critical hotspots along major transport routes that need to be prioritized in terms of setting up a new RWC in line with the scaling and expansion strategies of the organization. A feasibility study is done for the identified critical hotspot to assess how practical and beneficial it is to set up the RWC in that area, considering issues like cost, logistics, and whether the projected impact of the center justifies the investment. Funding is identified and allocated to the project and this kicks off implementation. The structure of each RWC is made of a converted shipping container which is adapted to accommodate the objectives of NSA at the same time adhering to the standards of WHO and the national departments of health. As a result, they are comparatively cost-efficient and are often given as in-kind donations from transport companies.
A typical wellness center includes a clinic and an education area. Each center is staffed by a local team consisting of a medical practitioner and a behavioral change communication specialist, and this helps to provide employment to the local community as well. The centers are ideally low cost, easy to set up or move if a more optimal hotspot is identified and this enhances flexibility in the underlying concept of bringing treatment and prevention facilities to the target market. After setting up the structure, NSA then looks into issues of staffing, training, creating awareness and equipping the RWC to ensure that it is ready to open and serve its patients.
To provide an all-round STI prevention and treatment program for the target groups, Paul realized that services had to be extended to the broader public to include the communities around the hotspots. Thus potential sexual partners as well as local people who would be potentially affected or infected by the illnesses are also welcome to receive services from the centers. Although open to everyone in the communities, operating hours for a typical RWC are conveniently adapted to the environment of the mobile workers. Thus RWCs usually operate from 4-5 and 9-10 at night since this is the time most truck drivers stop-over to rest and refuel creating a busy environment around critical hotspots. The model was further adapted to incorporate treatment of other illnesses as well (not just STIs) to provide a holistic health services opportunity for patients.
The medical personnel at the RWC operate under strict requirements to procedures and guidelines from the departments of health in the countries where the centers are based, especially regarding diagnosis, prescription, and disbursement of drugs. This positions NSA as a link and agent of extending health services to the mobile community without interfering with ethics and guidelines in diagnosis and drug disbursement in the host country. Each RWC is therefore equipped with a software system which prescribes the exact drugs the medical officer should disburse to the patient, in line with guidelines from the government’s health department following the symptoms of the illness presented. Further, NSA has developed a software system called Corridor Medical Transfer System which captures and stores basic information and data about patients. This works like an electronic health passport to help the medical practitioners at any given wellness center under the network where the client may visit to understand his/her health history and administer the service without duplication and overlap. The system is able to use code numbers to identify a patient for privacy, so patients are not necessarily required to provide their actual ID details.
Paul works with national and regional health departments of governments, businesses and corporates, local and international organizations and the civil society to ensure maximum impact. Currently, NSA has over 70 partnerships with public, private, and social organizations including the following; International Transport Workers’ Federation, ORTEC, PharmAccess, TNT Express, UNAIDS, UNWFP, in their different capacities as strategic partners, donors or supporting members. Through these partnerships, in just over seven years, NSA has established fifteen clinics in East Africa, ten in Southern Africa, and in 2012, the first center was opened in Gambia, West Africa. Through these centers, NSA reaches 200,000+ patients per year; all of which are managed from NSA’s head office in Durban, South Africa.
Paul has plans to slowly make NSA fully sustainable. In this sense, he is developing a mechanism for franchising the model to young entrepreneurs who will create and manage new wellness centers by generating enough profits to reinvest in the centers to keep them running, without compromising the foundation and values on which NSA was founded. With the same goal in mind, in 2012, Paul launched the North-South-East-West training initiative, enabling heavy vehicle operators to learn on the job through a self-paced, professional, recognized training program. The program works with international as well as national drivers to addresses the issue of road accidents involving heavy vehicle operators from outside of South Africa. All these strategies together would enable NSA to create more RWCs within the region and beyond and reach the target of 100 by 2015, which would then reach over 85 percent of mobile workers, and hundreds of thousands of people in communities located along the routes.
Paul was born and raised in Durban, South Africa, until the age of 11 when he moved to Randburg, Johannesburg with his parents. From a relatively poor family, at 14 years old he saw an opportunity to make pocket money by car washing, which was not surprising, having been fascinated by cars (especially big trucks) since he was young. Paul mobilized his friends and started washing cars for people in and around his neighborhood for extra cash. At 19, he found his first paid job as an industrial electrician tradesman at Transvaal Electric Motors Limited. Paul later worked in various senior management positions in different corporate organizations, one being Chief Executive Officer for the Road Transport Education Industry Training Board in 1997. This is where Paul encountered and understood the threat that the transport industry faced with HIV/AIDS and other STIs in relation to truck drivers and mobile workers.
This led Paul to start The Learning Clinic, an organization that specialized in employee education development in the transport sector. One field of training was HIV/AIDS and Paul was strategically involved in the implementation of two major HIV/AIDS projects with the Road Freight Sector. Working with the Road Transport Industry Education and Training Board, he joined forces with the National Bargaining Council for the Road Freight Industry to design a program for this high-risk population with limited access to prevention services. This joint activity spawned the Trucking Against AIDS program and the development of seventeen clinics, providing truck drivers, mobile workers, sex workers, and communities with prevention, treatment, information, and referrals for a range of health issues including: STIs, tuberculosis, malaria, diabetes, hypertension, HIV/AIDS, nutrition, eye testing, and condom distribution.
With Trucking Against AIDS established by 2006, Matthew founded NSA to establish a regional health services network. The first RWC was also founded in 2006 in Qwaqwa, Free State. Paul negotiated with the Ministry of Health for an ambulance and a nurse and set up at a roadside junction talking to drivers about HIV/AIDS prevention and treatment. Truckers started queuing for services and most had STI infections of some kind. Paul was convinced of the need to expand to serve mobile workers and thought to use shipping containers as RWCs. By the end of 2008, it had expanded to Swaziland, Zimbabwe, and Zambia. In 2012 Paul was named Social Entrepreneur of the Year Africa by the Schwab Foundation for Social Entrepreneurship.