Super strong bikes help transform healthcare in rural Uganda

Until now the greatest obstacle Susan Apio has faced is getting to see the thousands of people who rely on her.

She is one of dozens of health workers who are using their new Buffalo bikes to get cross country to help people in rural villages.

Apio may face dusty filled paths, or deep sludge in wet conditions.

She's in a district called Lira, 442 kilometres (274 miles) north of the capital, Kampala.

The Buffalo Bicycle is a recent arrival.

Retailing for roughly $200, it is three times more expensive than the cheapest regular bicycle, many people haven't heard of it, or can't afford it.

With it's strong steel frame it's three times more expensive than the cheapest regular bicycle, and out of reach of most health workers who don't yet earn a salary.

It's promoted by World Bicycle Relief which says its durability in rough terrain results in fewer trips to the mechanic also meaning fewer maintenance costs.

The bicycle is also seen as a community asset.

Any one in her village can show up and ask to use it.

A man might wish to take his pregnant wife for a check-up, a woman might need transport to pick up HIV medication, or an injured child might need a trip to a hospital.

“It has helped me because when I am moving within the community I don’t take long, even I also don’t take time. it also helps me to cover a number of households within the community and also our facility is far we used to walk like for 1 and half hour reaching the facility the health centre but when they gave us this bicycle really it has helped me a lot to move to the facility,” explains Apio.

Hamuza Ali is the Monitoring and Evaluation Officer for World Bicycle Relief.

He says the organisation is aiming to widen distribution of the bikes into other poor and rural settings, some areas with refugees.

He says: “By solving mobility challenges that are within these areas we are also aimed at reducing the poverty levels, also equipping the people here with a solution to see that their household incomes are increased. However, we are now penetrating in other regions and you can hear that we have been in Fort Portal, we have been in Kabala we have also been in west Nile that is Yumbe, in the refugee settings that is Bidibidi, and Adjumani.”

Another community worker Lucy Abalo says the bike means other villagers are able to help themselves.

"I have some clients here who go and pick the drugs most especially and that is the most important thing that this bike is doing here in this community. There are people with underlying conditions they pick their ARVs (antiretrovirals) from our facility and I know them, so sometimes I also get busy, but whenever they come they pick their bikes and go and pick their drugs,” she says.

World Bicycle Relief, a Chicago-based nonprofit, promotes the Buffalo Bicycle in remote parts of Africa.

It collaborates with governments, non-governmental groups and others who use the bikes to improve access to health services.

In Uganda, an east African country of 45 million people, efforts to market the bicycle have focused on supporting health workers like Abalo, who visit people’s homes and reports any issues to authorities.

As a community health extension worker, or CHEW, she has gained the trust of villagers, who can knock on her door in emergency situations. She said she helps to look after about 8,000 people in the area.

And at least twice a week, she is required to report to a government-run health centre about five kilometres (three miles) away and assist with triaging patients.

Abalo received her Buffalo Bicycle from the health minister last year.

One of her neighbours, Babara Akello says she has used the bicycle at least six times already. The first was for transport to an antenatal check-up.

Akello who now has a young baby, is grateful for the service Abalo provides.

She says: “When I was pregnant, the date I am going back for antenatal I can inform her that tomorrow when you are going you come and help me and carry me there because I don’t have transport. Help me so that I can reach there very early, but I would come back foot, but she always says I will take you and I will bring you back. And then now days I have the baby already she can come and carry me if I inform her that today I am going to take my baby for immunization, she can come and pick me up I always move with her and coming back home she can also bring us back home.”

Ugandan health authorities acknowledge that one challenge for community health workers is transportation.

The burden of poverty here can leave health facilities lacking ambulances or even fuel to move them.

World Bicycle Relief, operating locally as Buffalo Bicycles Uganda, has collaborated with Ugandan health authorities since 2023 to equip 331 workers in two of the country's 146 districts.

Community health workers using the bicycles reported a 108% increase in households reached each week, and the time to reach health facilities dropped by nearly half, according to a study published in May by World Bicycle Relief.

The study shows that “mobility is not a luxury in healthcare” but a lifeline, CEO Dave Neiswander said in a statement released for the report.

Augustine Okwir a local community leader says the health workers are also raising awareness about health issues.

“Their health I think there is now improvement because most of the people, the young ones they were coughing, but because of sensitization she has been using this bicycle they have changed their lives there is good health now not like the other previous times,” says Okwir.

The impact of the bikes is being felt in the town as well as the villages.

Here at Ober Health Center IV staff say they're better informed about the health of communities they can't reach, helping to identify disease outbreaks quicker than would otherwise be the case.

Francesca Ayer the Assistant Hospital Administrator says: “I know they are supporting us with sensitization at community level, they are also supporting us to also identify certain ill health conditions at community level and hence informing us timely and hence enabling us also act upon them timely. Like of recent we have heard of the Mpox outbreak in our country and they are our primary eyes at community level.”

The Ministry of Health says it supports the wider distribution of bicycles across Uganda because frontline, community health workers save an unknown number of lives each year.