Bicycle ambulances have impact

Headnote

One of the biggest reasons for the large number of maternal mortalities in developing countries is the time and distance pregnant women have to travel to the nearest clinic to receive proper care. This is especially difficult and costly to poor families when time could have been used for working and providing incomes. To overcome this problem, Transaid have been developing bicycle ambulances (see AT June 2008). Gary Forster , Victor Simfukwe and Caroline Barber report on their impact.

Work by Transaid to review health service transport capacity in many African countries demonstrates that, with the impact on health of transport hard to distinguish from other health system components, transport management is ignored - at great cost.

Maternal mortality indicators are receiving much attention as the 2015 deadline for the Millennium Development Goals grows near. Maternal mortality is a good indicator to demonstrate the efficiency of an entire health system - the availability of transport, and medical supplies, the presence of trained health staff, and so on.

A patient survey in Ethiopia highlights the mobility issues faced by pregnant women. The Fistula Hospital in Addis Ababa found that it takes women in labour 1 1 hours on average to reach a health care facility able to address their needs. Access and the cost of transport, were the two most important factors contributing to the occurrence of fistula.

Emergency transport costs are an overwhelming burden for families across Africa, even over short distances. And delays in access to health services caused by these financial difficulties are a key contributor to maternal death, the prevalence of obstetric fistula and the increased vulnerability among women to both.

Intermediate modes of transport (IMT) for maternal health

The demand for IMT ambulances is significant among maternity cases. A bicycle ambulance project in Uganda found that one typical use was the transport of pregnant women, which accounted for 52 per cent of all medical indications for transport. A Malawi study pointed to significant benefits of using motorcycle ambulances.

IMT ambulances also provide combined health services transfer. For a bicycle ambulance project on the Zambia/ Malawi border pregnancyrelated cases accounted for 1 8.5 per cent of use while malaria cases were 30 per cent. Another such service, in Malawi, to improve...