Filling a gap in the referral system: Linking communities to quality maternal health care via an emergency transport system in six districts of Zambia

Authors: Mary Surridge, Cathy Green, Dynes Kaluba and Victor Simfukwe
Journal Title:  World Transport Policy and Practice
Journal Reference: 20(1): 7-26
Document Type: Journal articles
Publication Date: 2014

Poor physical access to health facilities is a challenge facing many rural communities in Zambia. Concerns about distance, poor terrain, lack of affordable transport options, and seasonal challenges such as flooding or impassable roads contribute enormously to delays in decision-making when maternal emergencies occur, and act as barriers to utilisation of other essential maternal health services. In order to bridge this gap, the UK Aid-funded Mobilising Access to Maternal Health Services in Zambia (MAMaZ) programme supported six districts to implement and test a range of locally-appropriate transport solutions. Remote rural communities established emergency transport systems (ETS) comprising bicycle ambulances, boats, oxen or donkey and carts, with the choice of transport largely dependent on the terrain. Some districts also operated a facility-based motorcycle ambulance service, which served communities within a 10 km radius of the health facility and links to the district ambulance service. Results from the programme were striking. The paper explores the extent to which the emergency transport solutions supported by MAMaZ offered a cost-effective and sustainable solution to the physical access barriers faced by rural communities in Zambia, and the extent to which the transport improved health outcomes. Key policy implications are explored, including the need for government to devise a transport policy which recognises the role of communities in providing transport solutions at the lowest level of the referral chain. “Ukwali insoke takwafwile abantu: where there were warnings people never died. The work MAMaZ is doing is warning us of the dangers that take our children and loved ones. Finally we have the light and we don’t wish to go back to our past, which is full of darkness. We will continue looking after and using our ETS (Emergency Transport System) wisely” (Translated from a statement by a community leader).

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Tags: Zambia, Sub-Saharan Africa, MAMaZ, Maternal health, Community engagement, Emergency transport, Community participation, Bicycle ambulances, Motorcycle ambulance service, Emergency Transport Scheme, Emergency Transport System,