Health access program bridges micro-finance, health for Uganda’s poor

November 22, 2017 By David Tenenbaum

Patients, mostly mothers and children, outside a clinic along Lake Victoria, Uganda. As the sign indicates, the clinic relies on health workers from the government Ministry of Health, transported by Health Access Connect (HAC). Kevin Gibbons/Health Access Connect

In 2008, Kevin Gibbons began research in Uganda’s fishing communities. His goal, as a student at the University of Wisconsin–Madison, was to understand how efforts to promote sustainable fisheries affected family income.

And then a series of “smack yourself on the forehead” moments caused him to switch gears from fishery management to the problem of access to health care.

Today, Gibbons is executive director of Health Access Connect (HAC), a non-profit that merges microfinance and health-care access in Uganda. HAC lends to taxi drivers wanting to buy a motorcycle. In return, the driver agrees to spend three days a month transporting government health workers to nearby villages for a monthly clinic.

Gibbons received his Master’s degree from UW–Madison in 2012 in conservation biology and sustainable development.

The first head-smack occurred during interviews at a fishing community on the shore of Lake Victoria, when he learned that villagers were still dying of HIV/AIDS, even though the government was offering free, effective medicine just three miles away.

Children fetch water at sunset at a fishing community on Lake Victoria, where many residents have difficulty reaching the health system. Kevin Gibbons/Health Access Connect

A second bit of enlightenment occurred at a remote island on Lake Victoria. “It was a very exotic trip, and I was enjoying myself,” Gibbons recalls. “When I asked about life on the island, my source said, ‘If I could leave, I would leave tomorrow. If I get sick, if a mother is in labor, or a child breaks an arm, it’s an eight-hour boat trip’” to the nearest clinic. Gibbons adds, “Afterwards, I didn’t see those hours-long motorcycle and boat rides in the same way.”

As Gibbons and HAC co-founder Carolyne Ariokot were incubating ideas to bridge the gap, a friend asked Gibbons for a loan to buy a motorcycle to use as a taxi, which is a standard way to get around in rural Uganda. “Mike Nsubuga walked me through the business,” Gibbons says. “Motorcycles cost $1,300, so most guys rent, which makes for an expensive, unstable livelihood.”

By 2014, he and Ariokot began to see a solution in micro-finance loans that would provide income and health transport.

HAC program director Carolyne Ariokot and borrower Mike Nsubuga discuss logistics. Mike paid off the first motorcycle loan in February, 2017, and now owns this cycle. Kevin Gibbons/Health Access Connect

Although treating HIV/AIDS had been the initial impetus for thinking about expanding the reach of existing health services, the goal has broadened.

“There are issues of privacy,” says Gibbons. “If that’s all we did, you would know that patients were HIV-positive. Also, there is demand for other services.”

Frequent clinic services include HIV and malaria testing, vaccines for children, family planning and perinatal care.

All care is delivered by government employees, Gibbons emphasizes, with HAC simply providing transport to and from the villages.

Lisa Naughton, who is chair of the department of geography at UW–Madison, says Gibbons was “a great communicator and a force for good in the world.” Naughton, who has studied the links between poverty and the environment in Uganda, says “you find people in the poorest remote areas, languishing, ill at home, because they can’t even get $3 to get to a clinic in a nearby town.”

With HAC’s win-win approach, she says, “A lot of young men are helping their homes and families by becoming motorcycle taxi drivers.”

HAC motorcycle loan recipient Steven Ssenkubuge delivers medical supplies to a mobile clinic in Uganda. Kevin Gibbons/Health Access Connect

Health Access Connect now has three full-time and three part-time employees. Motorcycle loans are just the start. HAC has bought four ambulance trailers that can trail behind a motorcycle, is surveying health access in Uganda, and it’s hiring. “The common thread is that we are always trying to serve the health needs of those in remote areas,” Gibbons says.

At present, HAC’s bread and butter is the micro-finance enabled transport of health workers. For the 18-month term of the loan, one motorcycle and its driver serve three villages with a monthly clinic. Then, if the driver has paid the loan every week, “he owns the motorcycle and is not obligated to drive for us,” Gibbons says. “At that point, we may keep them on retainer, or take the money and loan it out for another motorcycle.”

Committing three days will trim the driver’s income, “but it’s a great loan and a great opportunity,” Gibbons says. Over the 18-month course of one loan, he says, that driver can enable 2,625 people to be treated. “And it’s no problem at all to find guys who want a loan.”

Health Access Connect starts its annual fund-raiser on Giving Tuesday, Nov. 28.