North Star Alliance is providing much needed health care to Africa’s mobile workforce, such as truck drivers and sex workers at high risk for HIV infections. Wharton management professor Aline Gatignon recently interviewed Luke Disney, North Star’s executive director, about his work on the continent. Gatignon has done research on creating optimal partnerships to tackle socio-economic problems using data from North Star, in conjunction with Wharton’s Mack Institute for Innovation Management.
An edited transcript of the conversation follows.
Aline Gatignon: Can you tell us a little bit more about the work that North Star is doing?
Luke Disney: North Star Alliance was set up in 2006 by the United Nations World Food Program, with support from TNT Express, an express delivery transport company. [At the time, HIV] was having a devastating impact on supply chains in Africa, particularly sub-Saharan Africa. So, from the World Food Program’s perspective, this was really about their humanitarian supply chain. They were trying to get food from ports out to hungry communities. And in particular, in 2003, 2004, they were responding to a crisis in southeastern Africa. They noticed that they couldn’t find enough trucks to move the food from the ports out to the communities. And this was strange to them, because normally they’re pretty well prepared for crisis situations in these vulnerable areas. They have a list of all the transport companies, they’ve made estimates on the capacity.
But what they hadn’t calculated into their model was the impact of HIV, which was, you know, on the rampage at that point in this part of the world. … The local companies whom they rely on were losing truck drivers at an enormous rate. And that, as a result, was affecting their ability to deliver food. At the same time, … when they did analysis into the situation, they also discovered that the very supply chains they were setting up — and you’ve got to think of long supply chains, hundreds of trucks in some cases, going into areas for periods that can be up to two years in the case of a protracted relief and recovery operation — were also a factor in spreading HIV.
So, you had these communities – isolated or relatively isolated — which all of a sudden have this huge influx of truck drivers coming in. And at that point, they got very concerned, not only because of their own supply chain risk, but of course the ethical implications of trying to do good and at the same time, inadvertently bringing harm to some of these communities.
I remember the first time that I was in Africa, in an isolated community, when I actually met somebody who had full-blown HIV. It was a truck driver named Edward. And he was lying on his back in a hut in the middle of nowhere, literally. And you were just thinking to yourself, “How in God’s name did HIV get to this place?” And the fact that he was a truck driver is probably how he contracted it. And sadly, he brought it back to his village where he infected other people. So that was WFP’s part of the story.
“The local companies whom they rely on were losing truck drivers at an enormous rate. And that, as a result, was affecting their ability to deliver food.”
TNT Express, at that point, was busy expanding in sub-Saharan Africa and of course, as an express delivery company, also very reliant on the transport sector as a backbone to move packages, in this case commercial goods. So together, they had already started working together on improving logistics of food delivery. And they then turned their attention to this issue. And really, coming at it from a logistics perspective, as opposed to from a traditional public health perspective, they started to say, “Right, well, what’s the problem here?”
And the problem is that in sub-Saharan Africa and other places, truck drivers spend an enormous amount of time away from home in Africa. Long distance truck drivers can be away easily, for up to 22, 26 days a month, on these long trips, spending an enormous amount of time at truck stops, which are isolated, parked on the side of road where they interact with women who have been forced into sex work because of the lack of other economic opportunities — women who have no other way of making their living and feeding their families.
So you get these hot spots — what we call disease hot spots — growing around these truck stops, border crossings, ports. And this is where you get high risk groups like sex workers interacting with what we call bridge groups, truck drivers, who then take the disease — HIV in this case — back to their families. And it’s not just diseases like HIV. We also see for example, in the recent Ebola crisis in West Africa, that mobile populations again, play an enormous role in spreading the disease from one place to the next. So that’s how the whole thing got started. And the philosophy was, well if it’s happening at these hot spots, then the traditional health infrastructure of hospitals in highly dense populations in cities and towns is not going to work. We need to get the facilities or the services out to the people in these areas to prevent the disease from being transferred in the first place.
So we started by setting up small container-based clinics. We used shipping containers because they’re cheap and easy to manufacture, move around and also to control the quality. And if you’re inside one, it looks like a doctor’s office that you and I would see here. You know, we kit them all out. They’ve got air conditioning, they’ve got water, lights, electricity, of course. And we started putting down these containers with nurse-run teams — with outreach workers — at the different hot spots, and then building networks of them along the transport quarter.
As drivers move from one place to the next, and sex workers who are also mobile, we could start to build the continuity of care and get into these hot spots where the actual transmission was happening. So we started that in 2006, 2007. North Star Alliance was created as an independent organization to take this forward, because obviously, TNT and WFP had other things to do with their time. And since then, North Star has grown, almost 10 years later, into an organization with 35 clinics in 13 different countries at the moment. We’ve served over a million people. We’ve actually helped establish 50 different clinics in Africa, and transferred some of those to governments, others to other local partners. And the networks continue to grow and expand.
Gatignon: I remember back last May, I was visiting one of your clinics in South Africa. And I actually met a commercial sex worker who was at the clinic. Her name was Michelle. And she was telling me about the huge difference that the clinic had made in her life.