Those who follow the activities of the College of the Rockies international projects team on our website or Twitter at #COTR_Intl will be aware of our major maternal, newborn, and child health (MNCH) project in Kenya – MAISHA. Instead of talking in general terms about MNCH, the project design, or other general areas, I think it’s key to focus on one specific challenge for almost all development projects – transportation.
Our project is focused on increasing awareness of maternal and newborn health issues, and increasing demand for services such as antenatal care and skilled deliveries at health facilities. To accommodate this increased demand, we are working closely with stakeholders to scale-up existing Ministry-run health facilities.
All of this is of little use if people can’t get to facilities in a timely manner.
This was recently again demonstrated to me while travelling to MAISHA project sites in Kenya with our in-country team. The project is simultaneously running in two regions of Kenya that offer vastly different realities. One area – Nyeri – has historically been politically favoured, has many paved and well-maintained roads, and maternal and newborn health outcomes above national averages, in particular a skilled birth attendance rate of 74% (Kenya DHS). The other region – Migori – has a skilled birth attendance rate of 46%, critical infrastructure lags, and a higher birth rate than Nyeri (5.4 vs. 3.4). To summarize, the project is using intra-Kenyan training partnerships to reduce the extreme levels of maternal health inequality that exist.
The project team spent one very efficient day visiting project sites in Nyeri, able to cover ground very quickly. Working with the Ministry of Public Health and Sanitation, we were able to see eight rural clinics, talk with staff, assess training and equipment needs, and investigate which ones to engage in project activities. Then, off to Migori. The first order of business was to hire the proverbial expat NGO Landcruiser – after the project team had previously nearly destroyed two vehicles. Just how bad are these roads? Well, compared to South Sudan or Somalia, probably fantastic, but they still leave quite a lot to be desired. We did finally make it to Migori, and over the course of 1.5 long days, managed to visit four facilities.
As well as discussions with staff and patients, we were interested in assessing transportation realities. In particular, we wanted to know what kind of systems and tools these facilities were using for emergency transport. We encountered two facilities that were using motorcycles converted into ambulances, serving patients within 45 minutes of the facilities. Regrettably, neither motorcycle ambulance was operational, and hadn’t been for some time. Furthermore, the capital costs were high, maintenance costs were high and not budgeted for by the Ministry, and there was no effective system in place for patients to communicate with either the facility or with the designated ambulance operator. Due to this reality, and other obstacles, most women felt that it was better to just stay at home during childbirth, rather than wait for unreliable transportation to a facility. Along with other factors, this is part of the reason for the ongoing high rate of deliveries without skilled birth attendants in the Migori area.
This entire experience re-emphasized the need for effective transportation solutions; ones that consider local challenges, are affordable, meet patient needs, and offer high levels of sustainability. One of the most intriguing solutions I’ve recently seen is a donkey ambulance, designed by an innovative and enthusiastic gentleman who lives on a farm near Mount Kenya. This design has gone through a number of revisions, and the latest incarnation shows promise. Our project team spent an afternoon looking at the concept; test driving it, and brainstorming applicability to our needs. One aspect that sets this solution apart is that every component can be made by local artisans – the jua kali sector. This means it can be made locally, will be affordable, and can likely offer a chance for local entrepreneurs to develop a business opportunity in patient transport.
Is the donkey ambulance the solution to rural patient transport challenges? Will it allow women to reach health facilities in a timely and affordable manner? Perhaps – assessments will continue – but it is an inspiring example of local solutions to real obstacles.