摘要：Objectives. We investigated whether managed transportation improves outreach-based health service delivery to rural village populations. Methods. We examined systematic transportation management in a small-cluster interrupted time series field trial. In 8 districts in Southern Zambia, we followed health workers at 116 health facilities from September 2011 to March 2014. The primary outcome was the average number of outreach trips per health worker per week. Secondary outcomes were health worker productivity, motorcycle performance, and geographical coverage. Results. Systematic fleet management resulted in an increase of 0.9 (SD = 1.0) trips to rural villages per health worker per week ( P < .001), village-level health worker productivity by 20.5 (SD = 5.9) patient visits, 10.2 (SD = 1.5) measles immunizations, and 5.2 (SD = 5.4) child growth assessments per health worker per week. Motorcycle uptime increased by 3.5 days per week ( P < .001), use by 1.5 days per week ( P < .001), and mean distance by 9.3 kilometers per trip ( P < .001). Geographical coverage of health outreach increased in experimental ( P < .001) but not control districts. Conclusions. Systematic motorcycle management improves basic health care delivery to rural villages in resource-poor environments through increased health worker productivity and greater geographical coverage. Transportation is an essential component of health systems. In resource-poor countries, basic health care delivery is often stalled by the poor condition of health transportation. As a result, health care workers, essential medicines, and supplies may not reach villagers who live in remote areas. 1 Improvements in transportation that result in a more complete geographical coverage of health services delivery are associated with better health outcomes, such as a lower rate of childhood mortality and improved maternal outcomes. 2–4 The recent Ebola outbreak in West Africa highlights the importance of an adequate supply chain to provide outbreak surveillance, deliver supplies such as protective clothing, and transport health workers and patients. 5 To address the problem of inadequate transportation, Riders for Health (Riders), a UK-based social enterprise, provides and maintains fleets of high-quality vehicles for government-led health care in 7 African countries. Riders’ systematic vehicle management includes driver training, fuel, preventive maintenance, and on-demand repairs. 6 We conducted a district-level small-cluster interrupted time series field trial in Zambia to examine whether systematic motorcycle fleet management by Riders is associated with an increase in the delivery of basic health care services to rural communities compared with usual fleet management by the Zambian government.
