iPPP-Project Proposal

Cooperation with the Private Sector/PPP

1. Project Review

ID
iPPP-Project Title: Promotion of primary healthcare services and occupational health and safety for the Truck
drivers in Rajshahi
Country: Bangladesh Duration: TBA Date: 3 October 2010
iPPP-Project No PPP-Project manager (GTZ): E-Mail:      
      Dr. Andrea Knigge Tel.No:      

Partner: Private Company / Business Association

Name and year of Truck Driver’s Association/Union
foundation:
Contact person:
Address/Tel/E-Mail:
Products, services:
Annual turnover (€):       Number of Employees:       Commercial Register No.:      

TC-Program submitting the proposal

Promotion of primary healthcare services and
Program title: occupational health and safety for the Truck drivers in PN:      
Rajshahi
Program objective: Reduce the disability and death of truck drivers through improvement of Occupational Health &
Safety standards and improve Primary Health Care Services for the truck Drivers.

Short description of the iPPP-Project

The project would be working with the truck owners and the Truck Driver’ Association/Union. The project would
advocate the improvement of Occupational Health & Safety measures by persuading the Truck Owners to improve
the fitness of the trucks and by educating the Truck Drivers on the issue. The second objective of the project would
be the provision of subsidized or free health care services for the truck drivers and their families. The third objective
would be to increase the overall awareness level regarding HIV/AIDS amongst the truck drivers.

Costs
Total costs: Total Contribution of the Private Partner: TBA T€ %
Total Public Contribution: TBA T€ %
Total Contribution of Others: TBA T€ %

Total Volume of the Project: TBA T€ 100 %

Type of Promotion: Contribution Contract with PPP Partner: TBA T€

Public Consultancy with: Executive Organisation: TBA T€

Consulting: TBA T€
PPP-Project Proposal
Cooperation with the Private Sector/iPPP

2. Description of the project

2.1 Background
Although Bangladesh is a small country, variety of commodities are transported from one end of the country to the
other. The most common method of transportation of such goods is truck. As per the records of Bangladesh Road
Transport Authority (BRTA) there are about 71 505 registered trucks in Bangladesh. With an annual increase rate of
8% (Hoque et al 2008, p-1), the number would be around 77 225 by 2010. Of these approximately 15 000 truck ply
the roads of Rajshahi City Corporation. Rajshahi is the epicentre of the silk industry of Bangladesh. Moreover there
are a variety of industries that are growing in Rajshahi. Due to the growing economic activity, the influx of traffic has
also increased. As per the BRTA annual report 2008, Rajshahi has the highest casualty accident rate in
Bangladesh. The fact has been summarised in Figure 1 given below:

Figure1
Source: BRTA Annual Report 2008.

Any accident is recorder by the local police. But the irony is that, there are not enough police stations and in many
cases most of the accidents go unnoticed. Hence, the actual number of accidents could well be higher by a factor of
three (Hoque et al 2008, p-3). Table 1 below is the number of accidents as per official statistics.

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Table 1
Source: BRTA Annual Report 2008

It is also suggested that the majority of the accidenst are caused by trucks, which account for 37% of all accidents
(Hoque et al 2008, p-4). In most cases the accidents are fatal. Due to the resulting accidents many truck drivers
become disable or worst, expire. Further more the accidents also have a severe adverse effect on the families of the
truck drivers. From the truck owners side, the accident poses a financial loss. The exact figure of loss is not known
at this point and further research needs to be done in order to determine the value. The economic costs of roads
accidents has been well summarized in the article written by A M M Shawkat Ali, published in the Daily Star on the
18 the of April, 2004.

[Economic cost of road accidents The above study has estimated the national cost of road accidents. The
elements taken into consideration to calculate the costs include property damage, administration, and lost output,
medical and human. The estimated cost is Tk. 38 billion or US$ 644 million. This is said to be 1.5 percent of GDP
and three times annual expenditure of the RHD. The study has claimed that even the above estimate is
conservative because it has not taken into consideration such other factors as (a) number and cost of permanently
disabled, (b) travel time lost to road accidents, (c) value prevention i.e. how much public would be willing to spend to
reduce risk of road accident.
Economic impact on the poor The study (2003) referred to earlier has also drawn attention to the economic
impact on the poor caused by road accidents. It is said that the heads of households or their spouses are often the
fatal victims of road accidents. This has an adverse economic impact on other members of the families. It is
estimated by the study that about 32 percent of road deaths occurred to poor heads of households or spouses
compared to 21 percent for the non-poor. The study findings indicated that for the 70 percent poor, the household
income, food consumption and food production decreased following road deaths. For the non-poor, the impacts
were less with 54 percent reporting loss of income.
The coping strategy adopted by the affected families, as analysed in the study, shows that it is a combination of
borrowing and sale of assets for the poor. Compensation received by affected families is negligible. One-quarter of
the poor families are reported to have received private compensation compared to 14 percent of the non-poor.
Compensation from institutional sources is said to be virtually non-existent.]
[direct quotation]
All accidents are preventable if the right kind of measures are taken. The main reasons for accidents have been
listed below (Hoque et al 2008, p-5).
a) adverse roadside environment,
b) poor detailed design of junctions and road sections,
c) excessive speeding,
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d) overloading,
e) dangerous overtaking,
f) reckless driving,
g) carelessness of road users,
h) failure to obey mandatory traffic regulations,
i) variety of vehicle characteristics and defects in vehicles.
j) awareness of the safety problem by policy makers,
k) inadequate and unsatisfactory education,
l) safety rules and regulations and inadequate and
m) unsatisfactory traffic law enforcement and sanction.

The factors have been divided in terms of the groups responsible, in table 2

Truck Owners Truck Drivers Other/ External

overloading
variety of vehicle characteristics
and defects in vehicles
inadequate and unsatisfactory
education
excessive speeding adverse roadside environment
overloading poor detailed design of junctions
and road sections
dangerous overtaking carelessness of road users
reckless driving awareness of the safety problem by
policy makers
failure to obey mandatory traffic safety rules and regulations and
regulations inadequate
inadequate and unsatisfactory unsatisfactory traffic law
education enforcement and sanction

Coupled with the above factors ruthless driving hours are one of the main reasons for the debacle. Further more
new research has shown that the drivers medical condition will also indirectly influence an accident. In Bangladesh,
the drivers are not subjected to a medical test before employment. Such activity ensures that a pre-existing medical
condition, such as poor eye sight, go unnoticed and becomes a factor in a potential accident. The medical factors
which directly effect the driving ability of the drivers are (Whitelegg 1995, p-3):

a) Cancers

b) Gastro intestinal and musculoskelatal disorder

c) Fatigue

d) Noise and health.

Moreover, almost all truck drivers are drug users. The usage varies from injected to smoked. Any mode of drug
abuse has been deemed fatal for this profession. It is a common pratice by the drivers, to drive under the influence
of cannabis. The drivers smoke cannabis in order to cope with the pressure and fatigues of the long journey.

Furthermore, the truck drivers and their families do not have adequate access to primary health care and their
knowledge regarding STI, HIV/AIDS and TB is minimal. Due to this the truck drivers often resort to unsafe sexual
behaviours. The prevalence of injected drug usage amongst the group of truck driver also suggests that the group is
‘most at risk’ of contracting HIV/AIDS virus.

2.2 Description of the iPPP

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Due to the high rate of accidents, Rajshahi is the proposed site for the iPPP. As there are four main parties involved
the iPPP could be a very complex issue. The entities involved are:
a) The Truck owners
The truck owners in Rajshahi is currently represented by
1. Rajshahi Truck Owners Association

2. Rajshahi Truck Transportation Owners Group

The mode and number of members are not known. The number of trucks owned by each member is still
unknown. As the group is a stakeholder to the project the truck owners association is a strong potential
partner.

b) The Truck drivers

The truck drivers are currently represented by an array of unions and associations. The list is given below:
1. United Truck Labors Arrangement Federation

2. Bangladesh Inter District Truck Driver Union

3. Bangladesh Truck Driver Union

4. District Truck Labor Union

5. Bangladesh Federation of Road Transport Workers/Labors

6. Bangladesh Federation of Truck Drivers

Similar to the truck owners association, the characteristics of the unions are not known. As most of the
accidents and health factors are related to the truck drivers the group is a potent private partner.

c) The Roads and Highway department (RHD)

The RHD is responsible for the construction of the road and highways. As road construction is also in issue
in the project context, the RHD is a viable partner.
d) Bangladesh Roads and Transport Authority (BRTA)
The BRTA is the sole authority on the traffic rules and regulations of the country. As traffic laws are factors
in the project context, the BRTA is a potential partner.

Due to the administrative impotence of the government agencies, i.e. RHD and BRTA, it is proposed that the iPPP
be done with both the Truck owners association and Truck drivers association. The Rajshahi City Corporation, RCC,
should be included as the public partner. However, in the event of this iPPP being a success, the above mentioned
parties should be involved to bring about policy level change. Proposed iPPP structure is illustrated in figure 2

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Figure 2
1 Truck Drivers Association/ Union
2 Truck Owners Association/ Union
Proposed mode of operation:
Truck Owners Association
There are two associations representing the truck owners in Rajshahi. Both the associations and either of them can
be considered for the purpose of this iPPP. If one association is selected then it should be on the basis of
membership or total impact. The truck owners association will be mainly involved in improving the Occupational
Health and Safety (OHS) issues. The association members will subjected to undergo the following changes:
a) Mandatory medical test for drivers prior and during employment
All the members would have to make the truck drivers working under them and potential drivers to under go
certain medical tests that would certify their fitness to drive. The medical test would be conducted by
prescribed medical centres. The centres would carry out basic medical test along with test for HIV/AIDS.
The medical centre would certify all drivers as green, yellow or red.
Green would certify that the driver has no medical condition or symptoms that would adversely affect the
driving ability. Yellow would certify that the driver can drive if certain medications of specifications are
adhered to. Red would certify the driver is unfit for driving. The cost of the test will be borne by the
association with possible discounts from the medical service provider. The payment will be per driver tested
basis. In case of medication and other alterations the driver would bare the cost. For existing drivers, each
driver would have to take a medical test annually.
b) Revised driving hours
As mentioned above, fatigue from long and continuous drives is also a factor in accidents. The association
member would be subjected alter their driving regime in order to improve the safety. To persuade them to
do so, certain marketing strategies will be applied. The marketing strategy will be discussed at a later part of
this proposal. In pertaining to the revised driving hours the truck owner might make some financial sacrifice.
c) Improved fitness of trucks
All association members would have to comply with the standards proposed by BRTA. This standard should
be imposed and made sure that it is followed. Again this would require involvement of the government
agency, but due to their lack of enforcement power, the benefits of fitness of the fleet should be advocated
to the members. If possible, GTZ might recommend some dealers who would supply the certain parts for at
a reduced rate. This option would need further feasibility study.
d) Upgrading trucks for drivers safety
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This process would require the truck owners to go beyond the fitness level of the truck and add additional
modifications to make the fleet safer. This might include:
• Providing safety gear , e.g. sun glasses,
• Air conditioning in the driver’s compartment.
• Adequate lifting gear for loading and unloading of cargo.
• Fire extinguishers in case of fire.
• Changing of entire fleet.
e) Provision of free condoms at the garage.
As all the truck drivers would congregate at the garage. Provision of free condom would ensure increased
condom use. This action will also bypass the stigma of buying a condom in public. The supply of the
condoms will have to be free. For this purpose care Bangladesh has been contacted. There has been no
response from their side, yet.
f) Seminar and education sessions:
As stated earlier, the member of the truck owners, association have limited knowledge regarding rules and
regulation. It might be pretty evident that the owners would have total disregard for the rules. In this case the
financial benefits of under going the changes should be reflected to them.
The funding of the above activities will rest primarily on the association. The public partners will not subsidise any of
the activities. However, the public partners might strike a deal with the supplier to make the necessary adjustment
available at a cut price.
The existing membership structure will be reviewed for the purpose.
Two target groups have been identified for the marketing process, the truck owners association and the truck drivers
association. As these two parties are separated and have different agendas, varying strategies need to be devised
for the two parties.
Marketing mix: Truck owners
• Target audience

In improving the OHS of the truck drivers, the truck owners have a lot to contribute. As the truck it self has a
lot to do with the OS, the truck owners need to make necessary adjustments.
• Target behaviour

o Undertake necessary adjustments in order to improve the condition of the trucks and amend driving
times.

o Understand ensuring OHS can be directly related to the financial wellbeing.

• Product

By making changes the truck owners would have reduced rate of accidents hence diminished financial loss.

• Price

As the modification would vary from owner to owner, cost can not be determined. The types of cost that can
be incurred are:
o Maintenance cost

o Upgrading driving seats

o Upgrading vehicles (change the entire fleet to newer trucks)

o Provision of safety gear (e.g. eye gear, gloves)

o Installing air conditioning in the driver’s compartment

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• Place

The services will be offered in the truck garage.

• Barriers

The cost related to the iPPP might be higher and not sustainable by the owner. In addition to that the truck
owners might reluctant to veer away from norms.
• Promotion

It would be financially viable if an extensive marketing campaign is not conducted. It would be in the best
interest of the truck owners, if the financial benefits of the changes can be reflected to them for this purpose,
a detailed analysis of the costs of road accidents to the truck owners should be conducted. Coupled with
that, the amount of saving that can be made should also be strongly emphasized. The analysis should take
into account the following cost:
o Loss/ repair of vehicle after accident

o Compensation paid to goods owner

o Any other compensation paid

o Annual vehicle insurance premium

To further entice the truck owners, GTZ might provide a certificate stating that the owner has made
significant upgrade to his/her fleet, which might reduce the annual insurance premium. Further assistance
might be provided upon enquiry.
• Evaluation

A baseline survey should be created for evaluation purpose. The baseline results should outline the
accidents caused over the past year. Afterwards, every three months the same analysis should be done and
the cost savings should be calculated.
Truck drivers association
The truck drivers would play the significant roles in improving the OHS and PHC. The association selection criterion
would be similar to that suggested for the truck owners association. The following activities will be undertaken:
• Free OHS workshop & STI, HIV/AIDS & TB Seminar
There would be training session for the truck drivers emphasizing the need to practice safe driving. In the
seminar the drivers would be taught defensive driving skills. In addition to that the drivers would be
enlightened with elements contributing to accidents and how to refrain from those elements.
Coupled with the safe driving training a seminar will be organized, in which a celebrity preferably originating
from Rajshahi, will outline the driving techniques. Local political leaders might also be included in the
seminar.

Celebrity endorsed campaign are common in the west. The idea is spreading in India as well. Very high
profile celebrity endorsed HIV/AIDS awareness took place in 2007 in Rajasthan, India, involving Hollywood
actress Ashley Judd and Bollywood actor Akshay Kumar. In the seminar the two actors addressed men and
woman of the community. They talked about the use of contraceptives, especially condoms. The actors
even demonstrated, using a fake male genitalia, how to use a condom. A similar seminar can be held in the
area with a prominent Dhaliwood (Bangladeshi Film industry) actor. For reference please visit:

o http://www.indiacurrents.com/news/view_article.html?
article_id=e9f3fdcb9cac4f37aad8f3b8768a36d5

It is essential that celebrity endorses the seminar. Any celebrity endorsement helps to reinforce the idea and
gives credibility to the cause.

The seminar will be conducted by RCC. The RCC trainers will be trained under a TOT conducted by GTZ.
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Each party would be expected to bear their individual expenses. In the event of a celebrity endorsement, the
cost can be shared between the two public partner.

• Free safety gear:

Free safety gear such as goggles, gloves or medication can be given out for free. The cost of the endeavour
will be borne by GTZ. This event might be conducted along with the event stated above.
• Discounted PHC services
As it is expensive to implement a free PHC service network, this iPPP will make available PHC services at
lowered rates. The rates will be fixed by the private PHC provider, e.g. Smiling Sun. As there are some
issue regarding disbursement of medication on part of GTZ, RCC can be made to accept donations in the
form of free medicines from Pharmaceutical companies operating in the region. The cost can be subsidized
by channelling a fixed portion of the subscription money generated by the association to the PHC service
providers. Further more financial donations can be sought from private enterprises operating locally.
For the sustainability of the iPPP, the subscription provided should be in the region of 1.5-2.5% of the truck driver’s
average monthly income. At present no data is available regarding the incomes of the truck drivers. This data is
essential in setting up the iPPP.

Marketing mix: Truck Drivers

• Target audience

Truck drivers are at risk group for HIV/AIDS. Coupled with their state of OS and lack of knowledge regarding
PHC, their situation is quite serious.

• Target behaviour

o Understand the role of OHS and comply with OHS guideline prepared by concerned agency.

o Change health care seeking behaviour

o Increase awareness about HIV/AIDS and TB.

• Product

Efficient health care provision of basic health services would significantly improve the truck driver’s
livelihood.
o Improved OHS.

o Better access to PHC services

• Price

To avail the benefits of the iPPP, the truck driver would have to enrol into a truck driver’s association or
union. The members would be required to pay a fee to the association in order to avail the benefits.

• Place

o Selected medical centres

o Employers garage

• Barriers

o Reluctance to change behaviour.

o Comprehension of monthly payment resulting in increased OHS and PHC

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o Reluctance to pay 1.5-2.5% of the average gross income.

• Promotion

The promotional activity has to be multilayered. The promotional activity should reflect the following issues:
o Woes related to OHS and PHC

o The benefits of the iPPP

o Methods of saving the required subscription fees.

The promotional activity would start from advocacy of OHS and PHC. For this purpose a rigorous campaign
should be undertaken. The campaign should include:
o Posters, Flyers & stickers.

A series of poster and flyers should be produced and distributed in the areas where the Truck
drivers gather. The poster should depict the hazards of not having proper OS measures and the
PHC issues. Coupled with that, flyers should be distributed manually. The posters should be done
first and then the distribution of the flyers.
o Public announcements

After the above has been conducted, routine public announcement need to be made addressing the
truck drivers. The addressing could be done from a predetermined focal point with the mikes placed
at various places. The speaker or the tape would announce the various issues related to OS and
PHC. The continuous exposure to these issues would act as a reinforcing agent.
o Seminars

This activity would give credibility to the above events. A seminar endorsed by a celebrity would
give a sense of reliability to the target group and hence any effort to enrol the Truck Driver would be
easy. The seminar needs to be conducted at a location where the truck driver would be
comfortable. A conference hall will not adhere to this hence a stadium or a space with enough
clearing would be suitable. The seminar would directly address the Truck drivers regarding the
issue and then introduce them to the facilities those are being provided by the iPPP. In the seminars
the speaker would relate to the earlier promotional activities and emphasize more on the iPPP
measures. The speaker would also make recommendation on how to manage their financial issues
for paying the desired level of subscription. The truck drivers should not be the main focus of the
seminar. The wives of the truck drivers should also be welcomed to the seminar. The speaker
should also try to connect with the wives and reflect what they might face in the event of their truck
driver husband being disabled or dead. This effort would, to a certain point, ensure that the decision
to join the association is jointly made.
o Rallies

Rallies are common method for getting attention regarding an issue. Rallies get newspaper
coverage and with correct persuasion get broadcasted on TV channels.
o Radio adverts

It very likely that the truck drivers listen to something during their travels. If the medium is a radio
channel, then this avenue can be used to deliver advertisements regarding the issue. For this
purpose, an enquiry should be done to assess the existence of any radio channel in the region. An
alternative to this would be planting verbal adverts in cassettes which are locally produced. The
local cassette producer may be contacted and an advert can be placed.
o Free give-aways

Nothing attracts the Bangladeshi mentality more than free stuff. This aspect can be exploited. Free
T-shirts can be given away to the truck drivers bearing the message related to the iPPP.
o Religious advocacy

Mosques and other religious amenities can be used to promote the initiative. The religious clerics
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can be persuaded to advocate the matter and they would directly refer the avenues from where the
truck drivers would be able to get membership.
o Advocacy by the truck owner

As the truck drivers come directly in contact with the truck owners, the peer education program can
be used to deploy the message. The truck owners would directly refer as an authoritative order to
join the association and maintain continuous membership. The possibility of making the
membership compulsory for employment can be exploited as well. In return the truck owner might
be given incentives for each referral.
• Evaluation

The evaluation of the promotion campaign will depend on the periodic increase in the number of
membership of truck drivers. A rate must be fixed as the increase percent and any non conformity in
achieving the rate will be deemed as a failure. Again for this purpose, a break even analysis will be required
to better direct the resources. The table 3 below shows a Sample of evaluation sheet

Membership
a) Contribution by the private partner
Yet to be determined

%Increase
b) Contribution by the public partner (GTZ)
Yet to be determined

Conformity
c) Contribution by 3rd party (if any)
Yet to be determined

Break-Even: 25
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2.3 Relevance of the iPPP-Cooperation to the private partner/s

The Truck owners association is an entity that takes care of the welfare of the truck owners. As the proposed iPPP
would significantly reduce the financial losses, there is directly relation to the iPPP with the truck owners
association.

The truck drivers association is a similar organization, and the implementation of the iPPP would develop two
aspects of the members’ daily life i.e. OHS and access to PHC. Hence is poses significant relevance to the
organizational goals.

2.4 iPPP-Program related measures and activities undertaken up to now

2.5 Development impacts and effects of the iPPP-Project

Please describe positive results that cannot be directly attributed to the project (indirect impact)

Please specify the contribution to (if any):

a) MDGs:      
b) HIV/AIDS:      
c) Environment:      
d) Gender:      

2.6 Risks and challenges

Please describe potential risks and challenges that might jeopardise the success of the project; and indicate
possible countermeasures

2.7 Results after termination of the iPPP-project

For final report only – will be completed by GTZ after termination of the project

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ANNEX:

Project Planning matrix

Project Objectives

Results, indicators and activities

Result 1 Significant change in the health seeking behaviour amongst the Truck Drivers and their families.
In comparison to the initial KABP, an overall increase of 75% of the target group in seeking
Indicators
appropriate PHC service.
1.1 KABP analysis
1.2 Provision of subsidized PHC services.
1.3 Marketing and advocacy of PHC services
Activities 1.4 Selection of appropriate PHC centres for delivering the services.
1.5 Building a network of PHC service providers.
1.6 Regular monitoring of the services being availed

Result 2 Major increase in the awareness level regarding STIs, HIV/AIDS and TB.
In comparison to the initial survey, 80% increase in the level of awareness amongst the truck
Indicators
drivers.
2.1 Conducting Survey
2.2 Peer education program
2.3 Provision of free Condoms
2.4 Selection of peers
2.5 Training of peers
Activities
2.6 Distribution of posters and flyers
2.7 Seminars and meetings
2.8 Celebrity endorsement
2.9 Periodic monitoring of the level of awareness.

Result 3 Improve OHS

Indicators 65% of the truck owners and 95% o the truck drivers undertake proper OHS measures.
3.1 Advocate importance of OHS to truck owners
3.2 Persuade truck owners to undertake necessary measures to improve OHS
3.3 Advocate the importance of OHS to truck drivers
3.4 Persuade truck drivers to change behaviour so as to comply with prescribed OHS standards
Activities
3.5 Distribution of poster and flyers to advocate the issue
3.6 Seminars and workshops
3.7 Celebrity endorsements

Calculation*

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Description of Contribution Total (T€) Private Public Contribution (T€) Third

partner (T€) Partner (T€)
2007 2008 2009
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,0
0,0
Total volume in T€ 0,0 0,0 0,0 0,0 0,0 0,0
Total in % 100% 0,00% 0,00% 0,00% 0,00% 0,00%

Total GTZ in T€ 0,0

Total GTZ in % 0%

* Please move the mouse target on the spreadsheet. Use the right mouse button to open it

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Checklist

iPPP-Criteria
Yes No
Do the public and private contributions complement each other so that both partners achieve their
objectives at a lower cost, more effectively and more quickly as a result of their cooperation?

Would the private partner undertake the measure without the public partner or is the measure required
by law? (subsidiarity)

Does the private partner bear at least 50% of the total project costs?

Does the PPP-project distort fair competition within the business sector?

Does the scope of the PPP-project extend beyond the company’s core business? (No subsidy!)

Perspectives of continuation after termination of the iPPP-project

Integration in TC-projects or
Autonomous Scaling-up

Confirmation (Please confirm)

The project is in line with the sectoral priorities agreed with the partner country.
Please specify the sectoral priority:           

The estimated cost of the project and the private contribution are in accordance with the financial
capacities of the private partner

The project has been approved by the GTZ in-country office manager

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