Rumphi District, located in northern Malawi hosts about 18 health care centres including 2 hospitals. Before TIC became involved, most facilities had no reliable, clean water and, broken or rudimentary sanitary systems. Medical hygiene practice was very difficult and therefore often ignored.

TIC helped regional health authorities and local entrepreneurs institute a program called STREAMS. Key to the program are ‘circuit riders’: independent contractors trained by TIC affiliates, who travel constantly between centres. Technical riders repair broken systems, do assessments and generally assist site managers with physical problems. Quality-of-care riders promote sanitary and hygenic practice through training, monitoring and needs assessments.

TIC designed the program with help from partners around the world and found the local entrepreneurs who run STREAMS as a business. TIC continues to provide training; mentoring of the small business entrepreneurs; liaison with health authorities; and, funding & coordination of resources for major initiatives such as recent major repairs to a maternity ward building.