A81 Emergency Transport experiences from Sub-Saharan Africa: public involvement in transport innovations to improve access to healthcare

Abstract

Abstract Background The lack of low-cost, efficient transport services for health has been considered an important barrier to improve access to healthcare services in developing countries. In rural areas, where formal ambulance services are generally absent, transport is scarce and patients have to travel long distances to access healthcare. In the context of recent efforts towards maternal and new-born mortality reduction in Sub-Sahara Africa (SSA), enhancing access of pregnant women, mothers and children under-5 to health facilities is a key element of success. Over the past decade, Transaid and other development partners have developed innovative approaches to Emergency Transport Systems (ETS) in collaboration with private sector actors and communities across SSA, particularly to serve women and children. This presentation provides a comparative analysis of Transaid’s experiences implementing ETS in four countries: Madagascar, Nigeria, Uganda and Zambia, focusing on lessons learned engaging communities and sustaining public involvement. Different approaches to ETS Rural regions of SSA have increasingly seen governments and development partners investing in public involvement for health, by supporting health-related volunteering schemes, aiming to increase availability of basic health service provision, including transport. In Transaid’s experience, public involvement in ETS can take different forms. In Nigeria for example, the National Union of Road Transport Workers (NURTW), a private sector organisation, is officially committed to an ETS at national level as part of its corporate social responsibility; NURTW taxi drivers transport women and new-borns in their taxis at fuel cost, acting as volunteers. In Madagascar and Zambia, Community Health Volunteers utilise bicycle-ambulances to deliver patients to the closest health facility; these bicycle-ambulances are managed by the communities themselves, who establish rules for maintenance/repairs and utilisation procedures. Motorcycle (boda-boda) riders in Uganda are attached to a health clinic and have agreed to transport women to health facilities for a reduced fare, in return for becoming the primary means of emergency transport for women in the community. Lessons learned and Conclusion Innovative approaches to ETS have been tested and expanded by Transaid, using different motivational, funding and organisational models. Two common key elements of success are the ownership of the ETS by its promotors or community volunteers and the community recognizing its value. Transaid’s experience from different contexts has shown that private sector actors and communities can effectively be engaged to help establish, maintain and manage Emergency Transport Systems. These solutions can therefore become alternatives or supplements to classic ambulance service approaches.