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Introduction

Even where services are provided free of charge, the costs of accessing the facility present a significant barrier to care. Poor transport services add to the financial barriers to care and compound the large distances that some women have to travel to reach a health facility. In one study of two rural districts, 65% of post- partum respondents said that they had waited longer than 2 hours for transport whilst in labour, with 30% of women having waited longer than 4 hours. Many labouring women even end up walking to health centres, either because of a lack of transport or because transportation was unaffordable (Ashwood-Smith, Bokosi and Matinga 1999).

Activities

Activity 3.1 Provide all village health committees with two bicycle ambulances

Transport from home to the health centre is the first phase of transport. The Mangochi Safe Motherhood Program and Mulanje Hospital have both implemented succesful bicycle ambulance projects. Key learning points are:

The ambulance should be a shared responsibility of the chief and other village health committee members to prevent private use.
Community input on the design of the ambulance is important. The community in Mangochi perceived the ambulance as a means of transport for dead individuals. A compartment for personal luggage and food for in the hospital was added to show that the transported individual was alive. This improved the acceptance of the ambulance.

Sixty ambulances will be distributed to village health committees. The bicycle ambulances will be distributed in phases to be able to observe community acceptance.

Link: Sakaramenta - Care Car

Back: Nkhoma Safe Motherhood Program - Overview

Activity 3.2 Provide motor ambulances to three health centres

In case of a complicated delivery a woman will be transported to the hospital. There are two health centres with an ambulance (Nathenje and Mthenthera). Three  health centres will be equipped with a motor cycle ambulance. The motor cycle ambulance is economically more efficient than a Landcruiser ambulance and is able to reach further into the community.

Link: E Ranger motor cycle ambulance

Link: Case study use of E Ranger motor cycle ambulance in Malawi

Link: E Ranger motor cycle on YouTube!

Back: Nkhoma Safe Motherhood Program - Overview