Observing Save the Children activities in Somalia in 1988, the Riders for Health founders noticed that health worker motorcycles were not being used due to complete breakdown. This became the impetus for a training, vehicle management and maintenance system. The charity developed out of technique testing programmes in Uganda and Lesotho, followed by a full national programme in Zimbabwe. The charity was registered in 1996.

In Zimbabwe, 80% of the rural population live in 40% of the country, accessed by only 3,000km of roads, mostly unpaved (country area: 390K km²). In Nigeria (area: 910K km²), road links and conditions are tenuous in sparsely settled areas. Half of the Gambia’s unpaved roads are in a critical or failing state (area: 11K km²). In all the target countries, dirt and earth roads become impassable in the rainy season, from June to October. The Zimbabwe health statistics below stand out as possibly unreliable given the known poor conditions there.

Another charity runs general transport services in Ghana, some Kenyan areas, Malawi and Zambia plus advisory services. It has very high fundraising costs and is not a current recommendation.