Technical Brief: USAID Community Capacity for Health Programme – A Bicycle Micro-Enterprise Approach to Improving Community Health Worker Mobility and Motivation in Rural Madagascar


In much of rural Madagascar – where over 60 percent of the population lives – a lack of access to affordable and reliable transport hinders uptake of health services. Community Health Volunteers (CHVs) are essential in health service delivery and have key roles in implementing the country’s strategy to achieve universal health coverage. Despite this though, they do not receive a salary from the government and face the same transport barriers affecting rural communities.

Transaid has been an instrumental programme partner in the establishment of “enterprise box” or eBox initiative, as part of Mahefa Miaraka’s broader integrated approach to address transport-related barriers to accessing healthcare. The eBoxes are bicycle sale and repair micro-enterprises managed by registered cooperatives that aim to overcome some of the transportation barriers face by the local population.

The eBox incentivises the ongoing participation of cooperative members through income-generating activities (IGA) and provides strategic support to other integrated transport activities including providing bicycles to selected CHVs to improve their ability to travel, maintaining local bicycle-ambulances, and increasing transportation options for the local community. The profit generated by the cooperatives also provides support to local health insurance schemes (mutuelles de santé and caisse santé) that reimburse participating community members for medical costs incurred at local health centres.

Click below to read the full technical brief.