Transport for pregnant women in Ethiopia

Africa has the highest maternal mortality ratio, with 830 deaths per 100,000 live births, according to the World Health Organization.

Antenatal services and care after giving birth, assistance from a skilled attendant and access to emergency obstetric services would reduce these figures.

Yet in rural areas where patients often travel long distances to reach referral health services without appropriate and affordable transport services, such essential care is difficult to achieve.

The Ethiopian National Forum Group (ENFG) has researched how to transport critically ill and high risk patients safely. In rural Ethiopia, where 85 percent of the population live, patients find it difficult to reach clinics or referral hospitals. The research shows that there are two main problems:

• The critical shortage of any means of transport in rural areas forces patients to walk long distances, resulting in a deterioration of their condition by the time they reach the health centre.
• Where traditional means of transport are used, the way patients are positioned for travel can cause complications. Common traditional transport includes: locally made wooden stretchers carried by four people, on the backs of animals or other people, or transport by horse or donkey cart, truck or any available car.

Such methods are problematic:

• Keeping patients in a safe and neutral position is often difficult.
• The delay in getting patients medical treatment can lead to additional health complications.
• Patients with severe and multiple injuries, such as cervical spine and spinal cord injuries, risk secondary organ damage.

The most vulnerable - those lacking adequate transport and suffering from poor health - are pregnant women and fistula patients. It is more challenging for medical personnel to perform life-saving activities and may result in patients dying from a secondary transport-related injury.

Two main policy recommendations arise from the research for local planners, decision-makers and government officials:

• Hardware - Physical access to health services would improve with integrated planning by health, transport and other government ministries. Better transport technologies, both motorised and non-motorised, such as bicycle ambulances for short distances, or taxi ambulances for medium and longer distances would help enormously.
• Software - In the short term, training materials to illustrate correct positioning of patients using traditional means of transport would help. These could be based on existing 'training of trainers' models used by health-related non-governmental organisations, community-based organisations and local health centres.

Taye Berhanu
Africa Beza College, Ethiopia National Forum Group, PO Box 13655, Addis Ababa, Ethiopia
T +251 (0) 9 663638 or 517246
tayeberhanu@hotmail.com

See also

Transport and Health in Ethiopia: the Impact of Traditional IMTs on Critical Patients, Presentation to the Transnet Workshop on Mobility and Health, by Taye Berhanu, November 2004
www.trans-web.ch/transnet/transnet8/

Toolkit on Gender Transport and Maternal Mortality, by Margaret Grieco and Jeff Turner, 2005
www.people.cornell.edu/pages/mg294/maternalmortality.html

The Impact of Transport Provision on Direct and Proximate Determinants of Access to Health Services, Swiss Tropical Institute, by Kate Molesworth, 2005
www.ifrtd.org/new/issues/Molesworth2005.doc

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