The research I looked at today was how African bicycle ambulances are being used to provide a more effective maternal health services.
This is an area of health services that has a high priority within the UN Millennium Development Goals and in Africa, this is an area of significant concern and where much aid effort is concentrated. One older Transaid project from Zambia, which implemented a number of bicycle ambulance projects in various regions in Africa, stood out for me in particular, so I thought I would share the project highlights with you.
Background to African Bicycle Ambulances
Transaid is a charity organisation established by the Charted Institutes of Logistics and Transport in association with Save the Children Fund. Its primary objective is to address major transportation issues faced by poor rural African health services. This project focuses on maternal health, as these indicators provide a solid representation of the efficiency of the overall health care system in a given area. Rural Africa faces severe patient mobility issues, even for short distances, with access and cost being the most critical factors, especially in emergencies and fistula cases. Additionally, the further demand and requirement for Immediate Modes of Transport (IMT) ‘is significant among maternity cases’ and this is most significant given that ‘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’ (Forster, Simfukwe, & Barber, 2010, pg 13). One example of the seriousness of this situation comes from an Ethiopian Fistula Hospital, which reports that it takes women in labour an average of 11 hours to reach a health facility that can provide for their needs – and this is in the urban capital city of Addis Ababa!
To increase access to urgent health care services, 40 bicycle ambulances were provided to rural communities in Zambia in 2008, which provided a free bicycle ambulance service for community members. This project was better thought out than a number of others I have read, mainly as the bicycle ambulances were allocated to community-based home carers (personal) and not assigned to be stored and/or work out of a health clinic (location). This is much more appropriate, as location issues such as access to a bike (if they are in a room or shed on location which is locked), or only having one particular staff member who has a key, limited clinic opening hours or collecting oxen to be hitched to a cart from surrounding areas, – have all often hampered response times in similar projects. Additionally, ten local field mechanics were trained to construct and service the ambulances, which was found to be a major success factor.
Bicycle Ambulance Design considerations: Three different bicycle ambulance designs were trialled and assessed. A design with a stretcher, full canopy and a non-flexible hitch was the considered the most comfortable and popular by riders and patients. Other interesting feedback considerations were:
• The bicycle should be permanently attached to the ambulance to extend the life of hitch apparatus.
• Rear wheel post frame hitching made turning more difficult than seat post hitching.
• Provision for a pump, basic maintenance tools and a first aid kit is needed.
• Lights were required for night-time call-outs.
• Bicycles needed to be lighter or adequate gears used for uphill trips.
• Clothing should be provided such as a high visibility vest and a rain jacket.
• The size of local door frames was an issue as the original prototype ambulance was too wide to fit through a standard Namibian door frame – which impacted on patient transference.
• During the whole program, the bicycle ambulances took 251 life-saving journeys – the longest trip being 40 km.
• During the pilot program (first 4 months), the bicycle ambulances were used 82 times to transport patients to health care facilities.
• By having a personal bicycle ambulance, 96% of the recipient caregivers were able to be more effective in their work.
• Travel time was significantly reduced (from 2.5 hours by ox-cart down to 30 minutes) by using bicycle ambulance.
• Patient safety and comfort increased – they could lie down on the bicycle ambulance instead of sit (or ride) on a personal bike.
• The bicycle ambulance canopy provides shelter (rain, mud, sun, animals) and privacy for patients (especially important for women who are nearing birth – i.e. waters breaking etc).
• Having a stretcher attached meant that river crossings were much safer and easier and the bikes were able to take walking paths that oxcart transportation was unable to manage.
There has not been any further monitoring and evaluation data from this particular project – but as it stands, this project seems to be a step in the right direction. It is encouraging to see bicycles being utilised to help address some of the most pressing and urgent health issues that disadvantaged poor African women face. It is incredibly important that such initiatives are investigated, promoted and disseminated. It is also a very humbling reminder for people living elsewhere, (like Australia) who can often forget how significant and urgent basic (community) health services can be.
Forster, G., Simfukwe, V., & Barber, C. (2010). Bicycle ambulances have impact. Appropriate Technology, 37(3), 13.