Thursday, October 23, 2014

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Accessing Health Services in Uganda: Boda Boda to the Rescue!

In rural Uganda, small motorcycles are being used as ambulances in a bid to make emergency healthcare accessible to those in need.
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An eRanger Bodambulance rushing to a hospital in Uganda. Photograph by Jon Shup.

Mbale, Uganda:

During the rainy season in Bushikawa, a village in eastern Uganda, the road from Zion Community Clinic to the nearest Health Centre IV is all but unreachable. A steep hill prevents most vehicles from attempting the journey; those drivers that try, find themselves stuck in the mud; and the many potholes on the route quickly turn into small lakes. It is not a place for vehicles – at least not most of them.

Thankfully, boda bodas (small motorcycles), ridden by intrepid drivers, can make the trip, even in poor conditions. Driving down the steep hill – a small mountain, really - they receive more than a few odd glances; some villagers are still getting used to the passenger sitting in the sidecar attached to the left side of the motorcycle.

The Boda Boda Revolution

These boda bodas are essentially ambulances. Known variously as mAmbulance (mobile Ambulance) or BodAmbulance, seven re-tooled boda bodas have taken more than 4,200 emergency cases within the Mbale, Manafwa, and Bududa districts since the first run in December 2010. The vehicles are made by The Ranger Production Company and called eRanger motorcycle ambulances.

The idea of using a motorcycle as an ambulance isn’t new – the British, French, and Americans did so in World War I – but Uganda is one of the first countries in Africa to implement it for rural emergencies. The scheme was thought up by Welsh paramedics and students from the University of Glamorgan while on a visit to Mbale, Uganda. The BodAmbulances are an innovative solution to a vexing problem as healthcare access for mountainous, rural villages is notoriously poor here. Sick patients and pregnant women cannot be expected to walk miles to the health centre, and cars are expensive and often unavailable – even when they can make it up the mountain. As a result, patients stay at home and aren’t tended to by a skilled birth attendant or other healthcare provider.

Indeed, poor access to health facilities is one reason that Uganda’s maternal mortality rate is stubbornly high – 310 deaths per 100,000 live births in 2010 – and, unlike many of its neighbours, unlikely to meet Millennium Development Goal (MDG) 5a of reducing maternal mortality to 170 maternal deaths per 100,000 live births by 2015.

Purchased by Partnership Overseas Networking Trust (PONT) and maintained with funds provided by Rotary International-UK and Kissito Healthcare International-Uganda, the BodAmbulances have one simple purpose: to save lives by helping sick patients access healthcare facilities that previously may have been out of reach.

Over 60% of runs take a woman in labour to the nearest Health Center IV or District Hospital. When every minute counts, a reliable BodAmbulance may prevent a mother-to-be’s uterus from rupturing, or allow a baby to be born before pre-eclampsia progresses to the life-threatening complication of eclampsia in the mother.

By reducing the time it takes to get to a health centre, BodAmbulances are helping to save the lives of mothers and babies alike. Jayne Brancher, project coordinator for Primary Health Care for PONT, says, “The clear objective is to reduce maternal and neonatal deaths. And in that sense, it has had an impact and reduced both dramatically”.

Free riders

Crucially, BodAmbulance rides are free, which allows all women in the region access to necessary health services, regardless of their ability to pay. All BodAmbulance drivers carry a cell-phone with airtime, and Village Health Team members are trained to call the BodAmbulance if a woman is in distress. BodAmbulances also serve as an important conduit between Health Centres and the local hospital, Mbale Regional Referral Hospital, for cases that require a higher level of care.

This allows the BodAmbulance intervention to positively affect two of the three components of the Three Delays Model: by reducing the financial, time, and “exertion” costs of reaching a health centre or hospital, it decreases the barrier to reaching care; and by giving health centres an easy way to transport patients to higher-level facilities, it reduces the delay in receiving adequate healthcare.

As a result of their success at saving maternal and neonatal lives and strong community support, PONT plans to purchase another 23 in 2013. And the effect the BodAmbulances have had on the community is tangible, says Brancher:

“It began to strengthen the way the communities help themselves through the Traditional Birth Referral Attendants. One woman said, ‘It’s given us back our self-respect; we have value within the community, and the community itself has become stronger.’”

Amendment (27/03/13): An extra sentence was added in third paragraph to include information about The Ranger Production Company, the company that manufactures the BodAmbulance vehicles.

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