title: Systematic Motorcycle Management and Health Care Delivery: A Field Trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Kala M
authors.initials: KM
authors.lastname: Mehta
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Francois
authors.initials: F
authors.lastname: Rerolle
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Sonali V
authors.initials: SV
authors.lastname: Rammohan
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Davis C
authors.initials: DC
authors.lastname: Albohm
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: George
authors.initials: G
authors.lastname: Muwowo
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Heidi
authors.initials: H
authors.lastname: Moseson
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Lesley
authors.initials: L
authors.lastname: Sept
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Hau L
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford.
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
mesh_terms: D000293:Adolescent; D000328:Adult; D016000:Cluster Analysis; D003150:Community Health Workers / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009049:Motorcycles / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D019035:Rural Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D014186:Transportation / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult; D015024:Zambia