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Paving the Road to Healthy Highways A Partnership to Scale Up HIV & AIDS Clinics in Africa

10/2008-5523

This case was written by Aline Gatignon, Research Associate, and Luk N. Van Wassenhove, the Henry Ford Chaired Professor of Manufacturing at INSEAD and Academic Director of INSEAD Social Innovation Centre. It is intended to be used as a basis for class discussion rather than to illustrate either effective or ineffective handling of an administrative situation.

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Source: North Star Foundation

Social Innovation Centre

Copyright © 2008 INSEAD 1 10/2008-5523

Introduction

“At the end of the day I think that Jeffrey Sachs1 said it best: one of the key things is making sure you’ve got a very simple, focused concept with easy-to-replicate technology. And if you have that, you can build up the critical mass. Then you have to be flexible and open enough to learn from the process itself and use that to improve your product offering.”

Luke Disney, co-Director, the North Star Foundation

Luke Disney felt proud of the North Star Foundation’s management team (see Exhibit 1) as he mused over the challenges they had overcome together in the past two years since the organisation was set up. Tasked with creating a network of HIV & AIDS clinics for truck drivers throughout Africa, they had discovered that leveraging the impact of a good concept by replicating or ‘scaling it up’ could be harder than it might appear. Yet despite the difficulties, they had come a long way and now had an impressive track record of treating and educating hundreds of drivers daily across the African continent to help them stay healthy.

However, Luke knew that the team could not rest on its laurels. Every centre set up was a victory, but keeping them running and growing the network of clinics remained an ongoing challenge. Somehow, before the year was out, he would have to present the board with a sustainable strategy to pave the way forward. “We’ve got a head of steam up, we’ve got momentum, we’re booking results and there’s growing interest”, he explained, “but we need something to push us up to the next level.”

If Truckers Won’t Come to the Clinics, the Clinics Must Go to Them

In 1998, the South African Minister of Transport, Abdullah Omar, appealed to the National Bargaining Council for the road freight industry to play a part in the fight against HIV & AIDS.2 He gave the Council, made up of transport companies and truck drivers’ unions, 50,000 rand (a little over €4,000) to address the issue in the industry.

Road freight is the number one means of moving goods through Africa, thanks to the network of transport corridors crossing the continent. Truck drivers and their assistants are therefore indispensable to the region’s economic growth. However, they lead hard lives with difficult working conditions and long hours on the road, which keep them away from their homes and families. A 2005 behavioural survey of truckers along the Northern corridor transport route from Mombasa to Kampala revealed that over 60% of those interviewed had spent fewer than 40 nights at home in the past year, while 6% of them had spent less than five.3 After a full day on the road or during interminable delays at border crossings, truck drivers and their

1 <http://www.earth.columbia.edu/articles/view/1804.> 2 Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). 3 Kenya. Ministry of Transport. Hotspot Mapping on the Northern Corridor Transport route: Mombasa to

Kampala. Comp. Morris, Chester N., and Alan Ferguson, December 2005.



assistants often spend the night with sex workers who congregate at truck stops. This has led to astoundingly high rates of HIV within trucker communities in Africa, which are at least twice as high as the general population4 and in some cases exceed 50%.5 Due to their high mobility, truckers are a vector of transmission for the disease throughout the region. As early as 1996 they had been identified as potentially the main dispersers of HIV infection in sub-Saharan Africa.6

Thus the task facing the National Bargaining Council was no trivial affair. The Council’s steering committee decided to start by analysing the scope of current HIV & AIDS programmes hosted by transport companies. After a tendering process, Paul Matthew, South African founder and CEO of an education and training consultancy for the transport industry called the Learning Clinic, was asked to tackle the issue. He recalled the initial reaction:

“Well, the first year it backfired. The employees just felt that it was a way to fire them. There was a whole stigma involved. They weren’t keen to take part at all. Also, a lot of transporters have big warehouses, what you call turnaround depots. And it’s more an administration office with maybe a small warehouse. But our focus was very much on the drivers, on the mobile population and not on the workforce that was going to the depot.”

As Paul sat in on one of the early information sessions, a couple of drivers came over to talk to him. They suggested that it would be easier if the programme didn’t occur in the workplace but rather in a more confidential, neutral setting. “And that really sparked the idea for me to take the project out onto the road rather than back into the workplace,” he recalled.

In July 2000, Paul took a caravan to a town called Harrismith, midway between Durban and Johannesburg along the major N3 highway. “I spent a week there by the side of the road,” he recounted. “It was a great success. The guys were attending the peer education programme and the response was just unbelievable.” However, by the end of the week a lot of drivers were coming back to Paul saying “I just learned in the training programme that I have an STI (Sexually Transmitted Infection). But what can I do about it?”

Paul realised that traditional healthcare clinics were often situated within town or city limits, where there was no parking space for the big trailers, which remained under the responsibility of the drivers. Moreover, clinics were only open during the daytime, whereas Paul had quickly realised that he had to revise the schedule for his peer education programmes because drivers would only start coming in at 9 o’clock at night before leaving again around 3 o’clock in the morning.

4 Kenya. Ministry of Transport. Hotspot Mapping on the Northern Corridor Transport route: Mombasa to

Kampala. Comp. Morris, Chester N., and Alan Ferguson, December 2005. 5 Along the main highway from Durban north to Zimbabwe, drivers and sex workers were found to have an

HIV prevalence rate of 56%, with 95% of those tested at one truck stop found to be HIV positive. South Africa Medical Research council. Targeting HIV-prevention efforts on truck drivers and sex workers: implications for a decline in the spread of HIV in Southern Africa, Comp. Ramgee, Gita and Eleanor Gouws, 2001.

6 Hudson, Christopher P. “AIDS in rural Africa: a paradigm for HIV-1 infection”, International Journal STD & AIDS Volume 7, Number 4 (July 1996) : 236-243.



When he got back from Harrismith, Paul ran what he called a ‘recce’, or reconnaissance of the drivers’ situation on the roads. He identified the major hotspots to target and, together with the National Bargaining Council, he developed the concept of the ‘Wellness Centres’ – two six metre-long (20ft) industrial containers combining an educational facility for STI prevention and a primary health clinic offering behaviour change communication sessions (BCC) and voluntary counselling and testing (VCT) for HIV & AIDS, as well as treating STIs and other illnesses and distributing male and female condoms.

Throughout the next couple of years, Paul dedicated a substantial amount of time and effort to creating a network of roadside Wellness Centres throughout the country, reasoning that the initiative would only have an impact on HIV & AIDS if truckers could access the clinics all along their route. In 2005, the Learning Clinic was bought by a major industry leader and the two companies merged to form IKAHENG under Paul’s direction.

Going Global with the New Kid on the Block?

In 2003, the United Nations World Food Programme (WFP)7 realised that its staff in the field were falling victim to the HIV & AIDS pandemic. In much the same manner as the South African National Bargaining Council, WFP asked Robin Jackson and Robin Landis from its HIV & AIDS department to analyse the agency’s workplace programmes addressing the issue. Very early on in the process, the two women realised there was a major gap in WFP’s HIV & AIDS policy.

The ultimate deliverers of WFP’s food aid to its beneficiaries are African truck drivers. WFP depends on skilled, reliable and experienced drivers, yet the agency’s HIV & AIDS team realised that their ranks were being decimated by the pandemic. Even more worrying, WFP’s drivers could be transmitting the disease to the very people the organisation was trying to help. Under the principle of ‘do no harm’ and the exigency of delivering food efficiently and responsibly, WFP had a clear moral but also strategic mandate to help its drivers deal with HIV & AIDS (see Exhibit 2).

WFP was confronted with the same problems as the South African National Bargaining Council, but in the case of WFP they were aggravated by the fact that the drivers were rarely direct employees as the agency sub-contracted to the transport industry for freight. How could the WFP address the prevalence of HIV & AIDS among a population which represented it in the field but to whom it had no access?

In June 2004, Robin Jackson turned to TNT, a major international transport and logistics company, for help. After CEO Peter Bakker gave an impassioned speech on the HIV & AIDS pandemic at one of the company’s global management meetings, he and Robin discussed the issue over dinner. Bakker said that TNT faced the same problems as the WFP in addressing HIV & AIDS in their emerging country operations. He promptly suggested that the two

7 WFP is the largest logistics provider of the UN agencies. In 2006, the organisation distributed 4 million

tons of food to 87.8 million of the poorest people in the world, many of them in Africa. <http://www.wfp.org/aboutwfp/introduction/index.asp?section=1&sub_section=1 as accessed June 6th, 2008.>



organisations tackle the issue together within the framework of their five-year partnership, ‘Moving the World’8.

In January 2005, 10 senior TNT managers were sent to Malawi with a team from WFP. Having spent a week identifying areas of common strategic interest, they presented their conclusions to their respective boards, which agreed to collaborate to address HIV & AIDS prevalence in trucker communities. As Robin Landis recalled, this was rapidly followed by action:

“With the weight of the organisation behind us, we very quickly put together a mission to go out and do what we thought would be a three-month feasibility study. After the first week on the ground we decided to reconvene and make it into a pilot, because every single meeting we had with the stakeholders, from government to NGOs to other civil society actors and a host of players – all said the same thing: ‘Enough of the studies. We’ve been studied to death.’”

What Paul Matthew now called the ‘Trucking against AIDS’ initiative had been brought to the team’s attention early on in the process. A dozen Wellness Centres were covering almost 95% of South Africa’s highways, resulting in a reduction of HIV prevalence in the country’s truck driver population by 17% between 2005 and 2006.9 However, there was still no way to address the health risks of the 13% of drivers who regularly delivered across borders and potentially spread HIV & AIDS from one country to another.10

Paul jumped at the opportunity when the TNT/WFP team invited him to Malawi to present his concept:

“My whole bigger picture has always been that if I’ve got drivers moving through South Africa who are crossing the border posts, they should continue getting education and medical support. And Trucking Against AIDS was going to the next phase, which was doing anti retro viral treatment (ARV)”.

ARVs are distinctive in that they are a lifetime treatment and cannot be interrupted midway through as this can provoke treatment failure as well as generate virus resistance to treatment.

A KAPB survey (Knowledge, Attitudes, Practices and Behaviours) was developed to identify hotspots along the continent’s main transport corridors. It was conducted through a combination of satellite mapping, interviews with truckers and female sex workers, and information from diaries which the latter were asked to keep. Results confirmed Paul’s initial insights as to truckers’ lifestyles and working conditions. All over Africa, truckers were

8 Tomasini, Rolando M and Luk N. Van Wassenhove. “Looking for a Partner: Moving the World. The TPG-

WFP Partnership”. INSEAD Case Study No. 02/2004-5187. Samii, Ramina and Luk N. Van Wassenhove. “Learning to Dance: Moving the World. The TPG-WFP

Partnership”. INSEAD Case Study No. 03/2004-5194. 9 UN World Food Program. Transporters Wellness Centres: Kenya Scoping Document. Comp. Cook,

Alastair. 2007. 10 Hector, D.A. “HIV/AIDS and its effect on the transport industry along main corridors in the Southern

African Region and within Malawi, Mozambique, Zambia and Zimbabwe.” Diss. University of Derby, 2006.



engaging in risky behaviour at overnight truck stops, involving unprotected sex with multiple partners.

On this basis, in August 2005, the WFP/TNT team initially set up a Wellness Centre at the Mwanza border crossing between Malawi and Mozambique, to test the findings and perfect the model (see Exhibit 3). TNT’s Malawi offices convinced one of their commercial partners to donate the containers for the centre, while the land was given by the Malawi Revenue Authority and the drugs were supplied by the Ministry of Health. An NGO partner was contracted to run the centre.

Within months, the Mwanza Wellness Centre proved to be an unmitigated success. One of the advantages to the new and improved Wellness Centres included an easy-to-install, user-friendly IT system which tracked a basic set of key performance indicators (KPIs) (see Exhibit 4). These revealed that the Centre had lower operating costs and better performance on KPIs than other existing initiatives. It received on average 50 visitors per day, which was equivalent to one truck driver visiting the centre for 2.3 trucks crossing the border. Other visitors were members of local communities and sex workers. “We were watching the client numbers increase every month through the monitoring and all the reports that we were getting,” said Robin, adding, “The community members accepted it. The drivers were being interviewed and they were telling their buddies about it and word-of-mouth was working.” (See Exhibit 5).

But both parent organisations were aware that creating a network of Wellness Centres would involve a whole new set of challenges. Although enthusiastic about the project and convinced by the pilot’s success, Robin Jackson thought: “I’m not in the business of opening and running Wellness Centres, right? And neither is TNT.” She felt very strongly that the transport industry itself needed to invest in the project: “They need ownership of it. If you look at some of the research that’s been done on the various sectors, transportation is the lowest in terms of its engagement in the AIDS pandemic.”

Because they were both major actors in their sectors, WFP and TNT felt confident that they could set up a framework within which this buy-in could happen over time. After a year of paperwork, it got off the ground on September 28th 2006 as the North Star Foundation (NSF), an independent identity incorporated in the Netherlands. Although board members were selected from among TNT and WFP staff, they envisioned a day when other corporate or humanitarian partners would become foundation members and join them in the organisation’s direction.

However, as the newly-formed management team started attending international conferences and approaching potential partners, they quickly realised that the NSF would have to depend on its original founders until it could prove its worth. Board member James Jenkin remembered his initial frustration when he discovered that the private sector partners they were counting on already had their own corporate social responsibility programmes and were not ready to join what they perceived as another company’s initiative. Furthermore, when he attended the XVI International AIDS conference in Toronto in 2006 with Robin Jackson and Robin Landis, they discovered that humanitarian players had their own reservations. Their response, he recollected, was, “Yeah, that’s a nice idea but until you’ve got something to show that you can do this and you’re actually offering expertise and you’re doing it well,



nobody really wants to. Funds are already tied up. People need to see statistics and results. Donors want all this formality behind them.”

So WFP and TNT agreed to cover the start-up costs until the foundation could build enough critical mass to get the stakeholders involved.

“At first,” said Robin Jackson, “there was some UN funding, but mostly there’s UN capacity at the country level that North Star Foundation would never be able to tap into without WFP. Just like WFP would never be able to finance this by themselves. Peter Bakker spent over a million euros on it. And in terms of setting it up, giving it a back office, putting two people on it, getting the head of Barclays Bank to come to a meeting at Davos, Peter’s done a number of things that WFP certainly wouldn’t have been able to do either. Also, I don’t think this is an across-the-board comment: ‘The UN is always looked at favourably or the private sector is always looked at negatively.’ I think it depends who you are pitching to and which piece of the puzzle you’re putting together. So there’s that nice complementarity because we have different networks.”

Despite these advantages, the challenges ahead nearly baffled the team, both internally and externally. Robin Jackson noted that,

“There are some very different corporate cultures, and so it took us a while to figure out how to work together. We just didn’t talk the same language. At the same time, we realised that it was a different world out there. There was a lot of catch up and doing your homework, talking to the players and finding out what they thought was important, what was missing – you know, like a market analysis. It’s as simple as that. Then afterwards you’re selling something that there’s an obvious need for.”

Boots on the Ground Count Ten Times as Much as Tanks on Paper…

Esther Bosgra, a TNT specialist on retainer to the North Star Foundation after three years as a programme manager for the Moving the World partnership, was packing her bags for Kenya where she was to set up the foundation’s local operations, when political unrest broke out in the country. As the NSF’s management team debated whether to target another country instead, the situation was resolved and Esther finally set off.

She was very enthusiastic about establishing a network of Wellness Centres for the NSF in Kenya. In her view, the hotspot survey had revealed a strong market potential: “One of the places where we are thinking of establishing a centre has, on average, 400 trucks parked per night with two people per truck and over 800 female sex workers.” Additionally, the UK Department for International Development (DFID) would be giving WFP close to a million dollars for a transport sector project on HIV & AIDS, which had led WFP to turn to the NSF to set up a network of Wellness Centres throughout Kenya. WFP’s backing would also provide the NSF with the leverage to mobilise a large number of stakeholders, since the UN agency regularly contracted 42 transport companies out of a total of 288 existing corporations nationally.



Esther soon discovered that her task was nonetheless fraught with challenges. Because of the length of the transport corridors, the NSF neither hoped nor wanted to go it alone. This meant that she had to mobilise the support of a number of different actors: UN agencies in Kenya for funding, NGOs which already had in-country HIV & AIDS programmes with which to network, the transport sector to get the drivers’ buy-in, and local partners to run the centres.

Although its association with WFP gave the NSF a lot of credibility and opened doors for Esther, she also chafed at the delays that it sometimes caused:

“Especially as in Kenya, where the money goes via WFP, we have to go through all their rules and regulations. Of course, a lot of the rules are there for good reason. For example, on quotations and so on there is a very strict WFP rule that for everything you buy you need to have three quotations. And for the bigger things that makes perfect sense, but it’s also for when you have to buy a computer or even something smaller.”

Upon arrival, Esther was also somewhat daunted by the task of linking the NSF’s network with other NGOs’ initiatives:

“There are 3,000 NGOs in Kenya, I was told yesterday. There must be some competition and I can’t imagine that so many NGOs work properly together. But one of my goals is to make sure that whatever we do on the transport corridor is linked to what other people do. And I really hope that at the end of the day we’ll be able to give out a leaflet in our Mombasa Centre with the services along the corridor for truck drivers, and then it doesn’t matter if it’s a Family Health International service or local NGO or NSF service or whatever.”

In fact, Esther was pleasantly surprised at the positive reception she got from other NGOs which she approached. Family Health International operated community centres in Kenya designed to address the root causes of HIV & AIDS by seeking to reduce economic vulnerability, gender-based violence, and alcohol and drug abuse. Their spokesperson was very positive about working with the NSF: “If the NSF can step up at other places on the road, we can build symmetry so a truck driver will be receiving services with a narrower focus.”

However, Esther also remembered from Paul Matthew’s initial model that creating a network of Wellness Centres was not enough. Without the transport sector’s buy-in, she knew that they would remain deserted. As part of her efforts to reach out to the transport sector, Esther contacted the Secretary General of the Kenyan Long Distance Truck Drivers’ Union, Nicolas Mbugua. The Union had been working with a number of local HIV & AIDS initiatives for the transport sector and knew how to overcome drivers’ concerns about stigmatisation: “I was also a truck driver myself for 20 years, so I know exactly what language to use to them,” he said.

On the other hand, Trucking Against AIDS and the NSF knew from their experience of working with the Federation of Eastern and Southern African Road Transport Associations (FESARTA) that they also needed to coordinate with local transport companies. Their ownership of the project was essential for marketing the Wellness Centres, for knowledge of



the local situation, to open doors to the national transport ministries and potentially access local funding opportunities.

Exhausted after so many meetings, Esther still had to tackle the number one issue facing the NSF: if the foundation did not directly operate the Wellness Centres, who could?

Growth Strategies for a Sustainable Future

Two years after the inception of the North Star Foundation, this problem was still keeping its co-director, Luke Disney, up at night. The foundation’s future hinged on the answer.

So far, the foundation had more than achieved the targets set for it by TNT and WFP. The management team had tested and perfected the model and had proved its worth to a growing number of interested stakeholders. The Foundation should have eight centres operational by the end of 2008, and currently had a number of funding proposals pending, including an opportunity to set up Wellness Centres in Vietnam through the Asian Development Bank. With start-up costs of $25,000 and annual running costs of $50,000, Wellness Centres had been “sponsored” by private corporations such as Chevron, by sector initiatives such as the South African Express Parcel Association and the Walvis Bay Corridor group, and by government donors such as the UK Department for International Development (DFID).

As it turned out, the running of the centres had proved to be more of a headache than Luke bargained for: “It’s perhaps the, or one of the key make-or-break factors in your whole business model.” So far, the Foundation had chosen to delegate the day-to-day operations to local partners.

“There are numerous advantages to outsourcing it. First of all, you build capacity locally – so we don’t just select the partners, we train them. We show them our KPIs, and make sure they can work according to the standards that we consider acceptable. More importantly perhaps, you invest in their organisation. The flipside, of course, is that with a new organisation we learn the hard way. Fortunately, we’ve been coached enough and have been wise enough not to just dismiss these guys but work with them and try to get them up to our standards, which is a much more labour-intensive approach, but it pays off.”

In the long term, a second advantage of outsourcing the Wellness Centres operation was that it kept the Foundation ‘lean and mean’. But until the local implementing partners could operate more independently, the NSF would have to find a way to fund the core costs incurred by these capacity-building efforts. Unfortunately, although stakeholders might sponsor a Wellness Centre’s operating costs for a few years, they were rarely willing to cover the Foundation’s overheads. This led Luke to formulate three strategic directions for the future to be presented to the board (see Exhibit 6).

• The first option for the next few years would be to expand the network by taking direct control of the establishment and operational running of the centres, thereby giving the NSF total control over the quality of the services. This would require the establishment of regional management teams with additional responsibilities, increasing the foundation’s core costs and limiting network growth to three new Wellness Centres per year. This



‘operator’ role would bring funding requirements to $2,881,385 over a three-year period (see Exhibit 6).

• A second possibility would be for the NSF to become a ‘catalyst’ for the network. The NSF would create legally independent regional divisions which would nurture a select number of local implementing partners to operate the Wellness Centres. North Star Foundation International would then retain two directors to provide regional divisions with support to cover insurance, governance and legal matters, procurement, international fundraising, and best practices. Although overhead costs would increase with the establishment of the regional divisions, these could eventually be spread out over a maximum of 15 Wellness Centres per division. This would also stimulate local stakeholder engagement as well as being the most cost-effective method for expanding the network. Luke calculated that this growth strategy would enable the foundation to establish up to 10 Wellness Centres per region every year, at a cost of $2,756,810 over a three-year period. However, this strategy would reduce the NSF’s control over quality by adding another layer of management at the regional level and keeping it dependent on implementing partners.

• The third strategy would imply a greatly reduced presence in the field for the NSF. The foundation would phase out its current operations and become a regional ‘expert’, advising other organisations in similar contexts, such as Trucking Against AIDS, Corridors of Hope and Family Health International. Some of the best practices that the NSF could improve and disseminate included management procedures, training programmes, websites, governance standards and learning materials for HIV & AIDS education. The NSF could also invest in data collection and analysis, and perhaps develop lobbying activities at the regional and international level. In this scenario, funding requirements would reach $2,963,350 over a three-year period.

As Luke weighed the costs and benefits of each of these scenarios, he could not eliminate the possibility that TNT and WFP might pull out of the operation altogether. Although he felt that this was unlikely in view of their strong commitment, he speculated that if this did happen the Foundation could potentially be ‘transferred’ to an African organisation, such as Paul Matthew’s IKAHENG, able to limit costs thanks to local management and perhaps even access more local or regional funding opportunities. On the other hand, he remained unsure as to whether this would be attractive to a third party recipient as the foundation’s contractual obligations would have to be maintained. Also, he worried that the failure or mismanagement of the project by a new owner could potentially taint both TNT and WFP’s reputation.

As Luke prepared for the upcoming meeting, he knew that his team had done its best to bring the project this far. But would it be enough to convince the Board that there was light at the end of the tunnel for North Star Foundation in the fight against HIV & AIDS?



Exhibit 1 Biographies of Key Case Study Characters

Peter Bakker

Peter Bakker is the CEO of TNT since 1 November 2001, after having been with the company since 1991 in various positions. It was on his initiative that TNT contacted WFP and set up the Moving the World partnership between the two organizations in 2002.

Esther Bosgra

Esther holds a Masters degree in International Relations. She has worked as a project manager on various TNT projects in the Netherlands and is currently Project Manager for the North Star Foundation in Kenya.

Luke Disney

Luke is currently co-Director of the North Star Foundation. Previously he worked for three years at TNT as Global Director of Communications for the Moving the World Foundation, which runs TNT’s partnership with the United Nations World Food Program. In the past Luke has worked as a senior corporate communications consultant where he specialized in corporate identity and branding projects. Luke holds Canadian and Irish citizenship. He currently resides in Utrecht in the Netherlands with his wife and two children.

Robin Jackson

As Chief of WFP’s HIV & AIDS service during the period evoked in the case study, Robin took the lead in linking WFP and TNT’s HIV & AIDS response by contacting the corporation’s CEO Peter Bakker about the issue. Robin was part of the original team which went to Malawi in 2005 to analyze how the two organizations could address HIV & AIDS together. Robin is currently Special Advisor to the Director for External Relations and Partnerships at UNAIDS, and Chairman of the Board for the North Star Foundation.

James Jenkin

James joined the TNT Group in the Netherlands in 1996. James has been involved with the North Star Foundation project since its inception and was part of the joint TNT and WFP delegation to Malawi in 2005. Since that time he has been actively involved in the set up of the NSF as an independent Foundation in 2006 and continues to be a NSF Board Member.



Exhibit 1 (cont’d) Biographies of Key Case Study Characters

Robin Landis

Robin is an HIV & AIDS policy adviser for WFP in Rome. She was part of the original team that went to Malawi in 2005 and then helped to set up the first Wellness Center at the Mwanza border post. Robin has been a driving force within WFP on the issue of HIV and transport and has been involved in North Star Foundation from the beginning. She is currently part of the North Star Management Team.

Paul Matthew

Paul is a South African entrepreneur. He grew up close to Port Elizabeth before moving to Johannesburg as a teenager, where he continued his education. He founded his company The Learning Clinic in 1996, providing consultancy services for training and education within the road industry. After Paul helped the National Bargaining Council to develop the Wellness Center model, the Clinic was charged with operating the Centers established in South Africa. It was then merged with Ikaheng in 2005, of which Paul is now the CEO. Paul currently lives in Durban with his family.



Exhibit 2 Conceptual Framework for the Socio-Economic Impact of the HIV & Aids Pandemic

on Firms

Source: UNAIDS, Global Business Council on HIV/AIDS and Prince of Wales Business Leaders Forum. The Business Response to AIDS: Impact and Lessons Learned. Geneva. 2000.



NB: Corridors of Hope, Trucking Against Aids and Safe T Stops refer to non-NSF HIV & AIDS clinics.

Exhibit 3 Transport Corridors Throughout the African Continent

East African Corridors and Centres




Exhibit 3 (cont’d) Transport Corridors Throughout the African Continent

South African Development Community Corridors and Centres

clinics.




Exhibit 3 (cont’d) Transport Corridors Throughout the African Continent

West African Development Community Corridors and Centres



Exhibit 4: NSF Management Performance Framework – KPIs

Top-level Process Critical Success Factor Key Performance Indicator Target Responsibility Measuring Number of Wellness Centres open X NSF/LIP NSF annual report KAPB survey carried out at all centres in last 24 months 1 LIP NSF annual report Total number of people passing through the centre Country specific centre staff IT system Annual operational standards, KPIs and strategy defined 1/year NSF NSF annual report

Understand, define and respond to

stakeholders’ needs

Provide high, quantified standards of customer satisfaction, which are

uniform across the NSF network, and subject to continuous evaluation

and review Number of evaluations 1/year/centre NSF NSF annual report

Number of days wellness centres open and fully operational 20 per month LIP IT system Number of attendees at BCC sessions country specific peer educator IT system Number of copies of BCC material distributed country specific peer educator IT system Number of male condoms distributed country specific peer educator IT system Number of female condoms distributed country specific peer educator IT system Number of peer educators trained country specific peer educator IT system Number of people reached by peer educators country specific peer educator IT system Number of clients treated by clinicians country specific clinician IT system Number of clients treated by clinicians for STI country specific clinician IT system

Number of occasions medicines needed are out of stock fewer than 10/Month clinician IT system

Number of clients referred to hospital/health centre country specific clinician IT system Number of clients counselled on HIV testing country specific counsellor IT system Number of clients tested for HIV country specific counsellor IT system

Number of occasions VCT kits needed are out of stock fewer than 10/Month counsellor IT system

Deliver primary healthcare and

health education solutions for

transport workers and the

communities with which they

interact

Wellness centres are staffed, resourced and delivering high-quality healthcare and health

education to customers in the targeted group

Number of monthly reports not provided by IT system 0 NSF Operational report Centre cost effectiveness ≤ $3/BCC/person LIP Operational report Sponsor report completed and delivered on time Monthly NSF NSF annual report LIP operational report delivered on time every Q LIP Operational report LIP financial report delivered on time every Q LIP Operational report

Deliver corporate

responsibility solutions to

sponsors

Provide sponsors with a method of fighting HIV,

quantifying their contribution for

communication to stakeholders Time to establish Wellness Centre after funding confirmed 12 weeks NSF NSF annual report



Exhibit 5 Benefits of a Wellness Centre Network

Operational data from Mwanza Wellness Centre from April 2006-March 2007

Source: North Star Foundation.

Schedule, Costs and Benefits for a Network of 20 Wellness Centres Rolled out Over Five Years




Exhibit 5 (Cont’d)

Predicted interventions made by a 20 Wellness Centre network rolled out over five years. Each centre has the same daily visitor rate, visitor breakdown and performance as the current Mwanza Wellness Centre.




Exhibit 6 Funding Requirements for Luke Disney’s Three Strategies for a Sustainable Future

North Star Foundation Funding Requirements under “Operator” Scenario (Branching)




Exhibit 6 (Cont’d)

North Star Foundation Funding Requirements Under “Catalyst” Scenario (Affiliation)


North Star Foundation Funding Requirements under “Expert” Scenario (Dissemination)

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Paving the Road to Healthy Highways - INSEAD · Paving the Road to Healthy Highways ... 10/2008-5523 This case was written by Aline Gatignon, Research Associate, ... Gita and Eleanor