Rural communities involved in the Partnership for Reviving Routine Immunization in Northern Nigeria/Maternal, Newborn and Child Health programme (PRRINN-MNCH) were mobilised to increase the access of socially and physically isolated families to community-based emergency transport schemes (ETS). These schemes comprised one component of a comprehensive community-based approach supported by the programme.
In the PRRINN-MNCH rural intervention sites, pregnant women suffering from maternal complications were often a long way from the nearest health facility, and a lack of affordable transport was a problem in all areas. Quite a few communities were home to commercial car drivers, many of whom were members of the National Union of Road Transport Workers (NURTW). In areas without a resident driver, there was usually one living in a neighbouring community. It therefore made sense to base an ETS on a resource that was already in place.
Working in partnership with the union, PRRINN-MNCH trained rural drivers to run the ETS on a voluntary basis. The drivers were sensitised about maternal health problems affecting the community, and received comprehensive training on their role within the scheme. An important part of the training involved increasing the drivers’ awareness of the need to extend the reach of the ETS to socially and physically excluded families. Inspired by the fact that they could make a difference, the drivers committed to being available ’24/7′, to keep the cost of transport as low as possible, and to work closely with other community volunteers, who notified them about vulnerable and hard to reach women.
ETS drivers in Katsina, Yobe and Zamfara assisted approximately 20,000 women between December 2009 and September 2013. After almost three years of implementation, communities realised that the ETS was for the entire community. As one rural resident in Zamfara said:
“Everyone gets the ETS services regardless of any factor”.
Drivers in each of the states were able to share stories of how they had helped vulnerable clients. One community in Yobe commented how the wife of a temporary migrant who lacked a social support network in the local community was supported by the ETS when she suffered a maternal complication. Community members in Yobe also described the efforts that had been made to assist women from neighbouring Fulani communities, an ethnic group that has traditionally been marginalised from communal life:
“Last year, one Fulani man and his wife came here to stay during the dry season and if not because of the group the woman would have died…The problem was prolonged labour. The family were poor with no relatives in the community. The fact that they could not pay for transport or medical bills was known to all in the community. The community volunteers supported the family. The family were assisted with funds from the community savings and an ETS driver transported the woman to the health facility.”
Efforts to mainstream a focus on social inclusion within the community-based activities supported by PRRINN-MNCH helped to shift community attitudes about the extent and nature of vulnerability and social exclusion and how these issues could be addressed. In rural northern Nigeria where mortality and morbidity are clustered among a minority of women, such efforts to reach the most vulnerable are crucial to achieving Millennium Development Goal targets.