In the years before 2006 in Malawi, TNT Express, a Dutch trucking company that used to offer logistics services for the UN World Food Programme, realised that their long-distance truck drivers were getting ill and dying. The cause and reason was unclear, and they went digging when they couldn’t find anyone to drive their trucks.
They would eventually find out that the truck drivers were dying of Aids and related illnesses, and they wanted to find a solution. The easiest answer was to convert a container to a mobile clinic to provide HIV prevention tools and counselling for drivers. That is how North Star Alliance was born.
“Research by WFP indicated that some transport companies had lost more than 50 per cent of their drivers and that an entire generation of truck drivers was at risk,” said spokesperson Arnold Otieno.
“With zeal to provide the much-needed health services, we thought, ‘If drivers can't get to healthcare, healthcare needs to get to them’. Over the past 15 years, North Star has done just that – delivered healthcare to this underserved population.
“The officials converted one shipping container to a clinic in 2006 in Malawi. After realising that this could be scalable they started to expand to reach out to more truckers. From then till now we have grown to 27 clinics in southern and east Africa.”
Known as blue box clinics, 12 have been set up in East Africa along transport corridors and 15 in South Africa to reduce cross-border HIV infections. In Kenya, seven clinics were set up in 2009 in Jomvu, Kipevu, Emali, Mlolongo, Maai Mahiu, Salgaa and Burnt Forest.
The containers are remodelled into roadside health centres for individuals with increased health risks, and are strategically set up at ‘hotspots’ such as border crossings, transit towns and ports where large numbers of trucks stop to load and unload cargo, and where sex work and informal trade flourish. Each blue box has flexible opening hours tailored to meet the needs of local clients, which often stretch late into the evenings.
“Initially, we used to offer primary healthcare – malaria, TB, HIV testing and STIS, but through research we also realised that these people were suffering from non-communicable diseases, so we started programmes to support them,” Mr Otieno said.
“We are donor-funded, but all our services are free except a clinic in SA where we require a fee for service.”
In Kenya, they set up seven clinics in 2009, targeting truckers who are vulnerable to new infections, as they stay away from their wives for long periods of time. The seven clinics have since 2019 assessed 243,694 services and handled 108,745 clients for primary healthcare, sexually transmitted infections and HIV testing.
“We interact with truckers and sex workers. Because these truck drivers stay away from their wives and families for long, and have a lot of money, they interact with female sex workers, other men who have sex with men, and others who inject drugs,” Mr Otieno explained.
“As more and more people cross borders for work, recreation, and safety, the risk of disease spreading from country to country and within countries grows. We are on a mission to guarantee that every truck driver and the communities they interact with have access to quality and reliable healthcare.
“Our mission is shaped around the concept that if they can’t get to healthcare, then healthcare must get to them."
Since they started operations, blue box clinics have held 2.7 million clinical and educational health sessions, with more than 145,466 clients accessing health services in the clinics in 2021. Their annual 2021 report shows that out of 67,047 truck drivers who accessed health services at the blue box clinics, 20,933 were tested and treated for sexually transmitted infections, while 27,144 went to seek HIV counselling and testing.
Some 9,544 sex workers also sought STI testing and treatment, while 15,453 sought HIV counselling and testing.
“To meet the UN's 95:95:95 goal, we had 17 roadside wellness centres offering ART services and 10 clinics offering PrEP in 2021. We had 1,050 HIV-positive clients with 941 of them enrolled on ART (93 per cent), 994 currently on ART (89 per cent), 594 viral loads (VL) suppressed (92 per cent),” Mr Otieno said.
But the job comes with challenges, with the main one bordering on the changing of the donor funding landscape, which has seen donors shift funding from HIV to matters such as climate change. Funding is also dwindling, as some donors withdraw funding altogether.
“Because the truck drivers move from one country to another, it’s quite difficult to monitor and ensure that they access their drugs. Countries have also not unified HIV treatment,” Mr Otieno said.
“If I am on antiretroviral treatment in Tanzania, and move to Kenya, what are the policies? We want a regional multinational organisation to address this matter so that if I am moving I am able to access healthcare easily.”
As the world marked World AIDS Day, North Star Alliance Director Eva Mwai urged policymakers to design regional health policies and guidelines that support people like truck drivers as they move across borders.
“We work at the crossroads of disease and mobility. There is no doubt that as more and more people cross borders for various reasons, the risk of disease spreading from country to country and within countries grows,” she said.
“It is therefore imperative that we look at regional policies, health guidelines and protocols that support these populations as they move across borders. An inexplicably close cooperation between health ministries of the various countries and non-state actors and agencies needs to be enhanced for the benefit of the critical masses.”.