Moving Health

Transportation is one of the top two reasons people around the world are unable to receive medical care. In many parts of the world, the funds and vehicles do not exist in rural areas to navigate the terrain to the clinic without exacerbating health issues. In developing countries, transportation delays are a major factor in high maternal and infant mortality rates. Ambulances are scarce and unsustainable because they are expensive and can’t withstand road conditions. Many mothers and infants die making the journey on foot or by motorcycle, and many who don't want to risk the journey die of treatable complications at home.   

Moving Health Ambulances are a safe, affordable, and sustainable solution that widens access to maternal healthcare by prioritizing local concerns. Our motorcycle ambulances are designed with community input, locally manufactured for easy maintenance, and can comfortably transport patients and supplies across difficult terrain, reducing the physical risk factors of the journey and supporting patients’ emotional health. Our ambulances have been in use since 2018 with programs in Ghana and Tanzania, and if scaled globally, could be a key factor in preventing deaths in the developing world. 

The Moving Health motorcycle ambulance is designed for the emergency transportation of laboring mothers in difficult terrain (although anyone in the community can be transported). Our participatory design process keeps costs down and allows us to create jobs for engineers, dispatchers, nurses, and drivers. We aim to make our ambulances as self-sustaining as possible by creating work for local manufacturers and building the local economy.  

Our ambulances cost 1-2% the price of a traditional ambulance, are manufactured locally for convenient maintenance, and include a tested suspension system that minimizes turbulence on difficult roads. Communities participate in our design process through interviews, focus groups, prototype review, and manufacturing. Every aspect of the vehicle is tailored to the needs of each community. 

In Ghana, the ambulances are engineered as an independent vehicle with additional space for a nurse and a family member, and feature a raised suspension to avoid deep potholes and puddles. They also include GPS tracking sensors, which track mileage, time, and other data—allowing the driver to focus on safely transporting the patient (as well as provide data to Moving Health).

After a successful pilot in Tanzania in 2018, Moving Health received requests to implement projects from over twenty-three different countries. We selected Ghana after careful consideration. Compared to urban locations, rural areas like Ghana’s Upper West Region, which houses the Sissala East Healthcare District, have higher maternal death rates, limited transport and access to healthcare, and a lower prevalence of skilled birth attendants and medical professionals. The slow decline in the maternal mortality rate prevented Ghana from reaching the United Nations Millennium Development Goal of 190 deaths per 100,000 live births by 2015. These problems are mirrored across the developing world, and we seek to reduce barriers to maternal and infant healthcare worldwide by providing adequate and affordable transportation for similarly underdeveloped areas.   

In Ghana, we partnered with The Virtue Foundation and traveled to Tumu, in the Sissala East Region of Ghana in February of 2020, where we held meetings with community leaders, health workers, medical team members, technicians, and women from eight different communities to discuss local pregnancy concerns and potential solutions. The team worked with technicians and artisans to alter the ambulance to the needs of the local environment, and built two ambulances that have been in circulation since February 2020. 

In 2021, we launched five pilot motorcycle ambulances with GPS sensors in the Sissala East district. The patient feedback and data encouraged us to start considering how to manufacture more ambulances and distribute them into the community.

The Moving Health team has spent six years becoming experts in emergency transportation, and our combined expertise in engineering, nonprofit operations, and local contexts create a holistic approach that positions us well for delivering this solution.  

We conducted hundreds of hours of research into emergency systems to learn about differences in staffing and equipment provision, implementation methods, and the local factors that determine a given system’s success. We worked with twenty public and private emergency response organizations in the region, and understand the contexts of this transportation gap and the considerations that need to be made to resolve this healthcare problem.     

Our Executive Director, an MIT graduate in mechanical engineering, works with our experienced, locally-contracted Ghanaian engineers to ensure that each ambulance model is functional, practical, and replicable with local resources. Our Country Director and Fundraising and Programming Officer, are Ghanaian nationals, with a deep understanding of the local contexts we are operating in. Our Ghanaian CD is well-positioned to both supervise Moving Health's Ghanaian operations and build relationships with local officials to expand and sustain the work. Dedicated Moving Health volunteers based in the US and Ghana assist with grant writing, Monitoring and Evaluation, and individual giving to supplement the work of our paid staff and build capacity. 

As Solve finalists, we have an acute understanding of the kind of direction the Solve network can offer, and our recent growth has put us in an ideal position to utilize that network. The past six years have proven to us that a community-centered approach is essential to the efficacy of emergency transportation, but that same approach makes expansion, distribution, and management significantly more difficult. We need the partnership of funders, local governments, and technological innovators to expand our reach and realize our potential. Since the launch of our first pilot program, organizations in many countries have expressed interest in partnering with Moving Health, and we are ready to scale our operation. The Solve community’s international scope and experience with both technological and programmatic innovation is exactly the type of support we need to make inroads in those countries and build a revenue model that will allow each program to become self-sustaining. Moving Health was born of an MIT class assignment (known, at the time, as The Okoa Project). The MIT community is one we are extremely proud to be a part of. With the tailored guidance and mentorship of the Solve community, we can further develop our operation and move a step closer to eliminating transportation delays in obstetric and other medical care. 

Of the challenges preventing access to healthcare, most nonprofits and aid programs address delays in deciding to seek care or in receipt of care. Moving Health focuses on one issue: the delay in transportation to receive care. The result? We are able to make an impact on rural communities that are otherwise neglected.  

Our solution improves on previous attempts by capitalizing on the use of local systems and creating designs in partnership with the community. We look beyond the patient's immediate medical need and account for community norms to bring safe and trusted transportation to the greatest number of people. At the same time, we create jobs for local nurses, technicians, and dispatchers (and eventually in our manufacturing facility).  

Other motorcycle ambulance manufacturers that have tried to fill this gap have been prohibitively expensive and failed to understand the local problems. South Africa’s E-Ranger cost $6,600 USD and encountered fatal maintenance issues that could not be repaired. Of the 400 E-Rangers purchased by the Tanzanian government, none are still in use. The Zambian Pulse Motorcycle Ambulance had an inadequate suspension system and required the customer to purchase a specific accompanying motorcycle, totaling $4,000 USD. Neither of these solutions provided space for an accompanying passenger, a feature we incorporated into our design after interviews revealed it to be the most important factor in reducing the fear of making a hospital visit. The participatory design process ensures that all concerns are addressed and all Moving Health ambulances can be locally repaired. Finally, the cost to build an ambulance is $3,000 USD. 

We have a contract with the Ghanaian Ministry of Health, and plan to  facilitate our expansion to all 260 health districts within the next 5 years. We want to establish our operation in Ghana as a model for innovative emergency care in the region. The Ghanaian government’s proactive position on addressing maternal and infant mortality combined with the need for vehicles to supplement the National Ambulance Service make Ghana an excellent environment for scaling our operations country-wide.  Twenty-three other countries have reached out to Moving Health to learn more about our transportation solution. Once we expand through Ghana, we can focus on these connections.

At the same time, we plan to refine our use and analysis of sensor data on each Moving Health ambulance to help us monitor and evaluate our programs. 

In 2022, we are looking at manufacturing facilities and hope to open one by the end of the year. We're sourcing materials now, and figuring out how to start manufacturing ambulances more frequently, thereby distributing more in the communities that need them most—as well as employing more Ghanian professionals in the region.

We built and installed GPS indicator trackers on all pilot ambulances, to help track rides, times, and other data that helps us identify trends, down times, and successes. In addition, we recognize that our vehicles have times when they aren't transporting patients. During these times, our vehicles and drivers have transported supplies and delivered COVID-19 vaccines to remote areas of Ghana. 

Through this data, we see the number of rides increasing steadily in the five regions we currently serve. From July, 2021 (the start of the pilot) through January, 2022, total ride usage increased each month across all communities—from three to five times as many riders as when we started the pilot.

But we don't just rely upon sensor data. We also interview patients who rode in our ambulance, asking their opinion of this healthcare transportation solution. We listen carefully to their assessments, from comfort to time traveled, and consider their opinions as we move forward.

Purpose: 

The purpose of Moving Health’s intervention in the Sissala East District in the Upper West State of Ghana is to help build and operate a sustainable, locally viable, medical transportation system that will provide better access for the region's population to medical facilities.

Problems:

•Current medical transportation methods lack expediency and reliability which serves as a time barrier to receiving crucial medical treatment

•The geography of the Sissala East District is a physical barrier to seeking medical treatment due to the very rough and rural terrain present in the district which hampers traditional transportation vehicles

•Expecting mothers and residents that are faced with a medical crisis often have to spend multiple hours sourcing transportation to a medical facility which is an access barrier

Strategies:

•Introduction of Moving Health Sissala model motorcycle trailer ambulances

•On site training of technicians, dispatchers, and drivers for the handling, operating, coordination, and maintenance of the motorcycle trailer ambulances

•Ensure Moving Health Sisala model sustainability

•Create sustainable infrastructure to maintain ambulances after initial implementation. Including job creation for local towns and populations and connecting the new medical transportation system into the larger pre-existing Ghanaian system

•Ensure low cost of intervention

•Utilizing locally sourced materials and the locally operated nature of the Moving Health transportation model to keep communal prices low

Target:

•Women and expecting mothers in Sissala East District

•Rural Sissala East District residents who require transportation to medical centers

•Sissala East District economically disadvantaged residents

Short Term Outcomes:

•Creation of initial Moving Health motorcycle ambulance transportation system•Initial decrease in travel times for medical patients

•Initial increase in medical transportation reliability

•Initial decrease of births on the side of the road

•Initial increase in Moving Health’s organizational capacity and intervention effectiveness

•Initial establishment of joint public private partnership between Ghanian government and Moving Health

Long-Term Outcomes:

•Region-wide usage of Moving Health's Sissala model motorcycle ambulance trailers for rural medical patients

•Medical travel times reduced to two hours or less

•Large sustaining increase in medical transportation reliability

•Near nonexistence of roadside births

•Significant increase in Moving Health’s organizational capacity and intervention effectiveness

•Moving Health operates as a critical government rural transportation resource

•Moving Health prepared to expand intervention to neighboring districts

Impact: Sissala East District medical transportation efficacy dramatically improves alongside noticeable economic improvement in the area. District wide health outcomes begin to improve.

Moving Health's solution relies on widely-known technologies, which we use as a foundation from which to adapt our ambulance’s design to a given community. To this effect, all ambulances are outfitted with a robust suspension system built to withstand extremely bumpy or muddy road conditions, a roll cage to protect passengers in case of traffic accidents, and a removable stretcher for patient transport. Individual ambulance models are modified from these fundamentals to include local considerations, such as room in the ambulance for a caregiver and/or family member. 

The mechanics of our ambulance are simple; dependability and familiarity of its technology is a key factor of Moving Health's business model. By emphasizing local manufacturing and reproducibility, Moving Health fosters long-term implementation sustainability that can be trusted to provide emergency transportation and grow the economy of local communities.  

Our staff members, board of directors, development committee, and volunteers exhibit diversity in ethnicity, gender, age, and geographic regions. Staff represent Asian, African, Indian and northern European heritage, and range from age mid-twenties to mix-sixties. Our board chair is a co-founder/woman, and our volunteers hail from Ghana to India, across the United States to California. The majority of staff is based in Ghana.

We don't believe geographical limitations should exist for people to receive medical care—nor do we think our supporters or staff should be limited to any state, country, or region. We have strong focus on human-centered design including community voices in all we build. We listen to the concerns and suggestions of the community members we serve and carefully consider them all as we design and build our vehicles.

As we look at expansion of Moving Health, we push to hire women, particularly Ghanaian women, as we grow. Emily feels privileged to be part of the MIT network, knowing she and her team have the power to make change and make a difference thanks to education, community connections, and a greater global understanding and appreciation that we are all connected in health.

Our mission to inclusion is at the heart of all we do—from simply scheduling meetings at convenient times for global staff, to understanding the challenges of terrain, transportation access, and healthcare in Ghana. Our core values lie in the belief we are one humanity, with our individual perspectives. We recognize them, respect them, and also seek to learn from others.

We are a company that provides collaboratively designed motorcycle ambulances as well as consulting and training services on how to best manufacture the products and conduct an ambulance service in a community context. We provide all of our services through a partnership model, in which we work with in-country partners strong community and institutional relationships and can build the capacity to manage an ambulance service once the product is developed and an operational infrastructure is established.  

 Up to this point, Moving Health has operated as a strict nonprofit that donates the time and capital to develop and manufacture initial ambulances, while our partner organizations leverage community relationships to encourage involvement in our needs assessments and gather the manpower to manufacture and operate the ambulance service. 

Our aim (which we are actively planning) is to move away from this strictly nonprofit model and toward a hybrid nonprofit/for-profit organization that would allow for revenue generation in addition to fundraising.

We are currently an organization that exists entirely on donations. From grants to the generosity of individual donors, the kindness of friends and strangers has kept us moving forward. 

In 2022, we are actively researching a way to enhance revenue as a way to expand Moving Health and ease the reliance upon the 100% fundraising model. Here's why:

Our goal is to keep growing. To expand into other communities that need us most. To bring our solution into these communities so they can have access to safe, affordable transportation. We want to expand across Ghana and provide an innovative new emergency transport model to every person who needs it. After that, we want to expand further.  

To do that successfully, it is important for us that these ambulances are sustainable.  

What does that mean?  

Sustainability for us means that the programs and ambulances that we create will be resilient. We do not want the services that we provide to be reliant on philanthropic funding forever; we want it to run itself. COVID-19 showed the world what happens to NGO-led programs that are only reliant on funding: if the money dries up, then the programs must stop—and thousands of people lose access to something they need.  

So how to move forward? As of now, 100% of our operating income is due to donations through individuals, fundraising events, or grants. We want to balance our income stream to make us healthier and less dependent on our donors. 

We are actively working on an earned revenue model, where we sell goods or intellectual property (in addition to traditional fundraising) to offset our growth costs. This is not an uncommon business model. Many nonprofit organizations balance their fundraising revenue with some sort of income. (For instance, The Girl Scouts sell cookies. Healthcare clinics bill for medical services. Performing arts centers sell tickets to events and performances. Boys & Girls Clubs across the nation balance their fundraising with program fees.) 

here are several factors we're considering, such as who should be the paying customer and what streams of revenue align with our values. We are exploring different expansion strategies so that we can grow in a sustainable, thoughtful, and resilient way. Emily will be in Ghana in April and will attend several meetings with potential customers (along with staff) that have indicated interest in partnering with Moving Health in some way.

Increased donations:

We have been a 501(c)(3) since mid-2019 and survived the pandemic by planning virtual events and expanding our marketing reach, and working remotely. Our annual income has increased each year, most recently 40% from 2020-2021. We are on target to double this income in 2022, thanks to a major donor who believes in our mission and leadership.

Building partnerships:

We are having conversations with several Ghanaian, women-centered healthcare-related businesses, from hospitals to clinics to transportation-related organizations. Emily travels to Ghana next month. Together with the Ghanaian team, she will be looking at potential manufacturing facility sites and participating in meetings with these organizations. Emily, our CFO and former board chair plan to return to Ghana over the summer to finalize plans. We have potential investors interested in funding this facility.

Business Plan:

Finally, we are building a business plan that incorporates both the nonprofit and for-profit side, to facilitate growth and sustainability. We are excited about the future of Moving Health. More important, we believe our solution will improve and save lives in rural areas of Ghana and beyond.