From 2010, the health transportation in France has become one of the top ten priorities of the risk management plan due to the increasing cost of these transports. For social and Medico-Social Institutions (MSI), this cost represents the second-biggest expense after that of the wages. In this context, the NOMAd project aims to improve the daily transportation service for people with disabilities between their home to MSI. To this end, we performed a field survey to identify the needs of the different stakeholders. This survey allows us to propose the transportation pooling among several MSIs on one side, and a global transport management process on the other side. This process makes possible to group and optimize routes on a given geographical area. The challenge is then to improve economic performance while maintaining social and environmental goals. A decision aiding tool for the transport optimization is proposed to tackle this problem.