How alternatives to traditional ambulances are improving health access

In the remote village of Cholomali in Nsanje district, southern Malawi, 30-year-old Marita Nyang’ombe recalls how desperate she felt when she went into labor, last October. Cholomali is a very remote area and with bumpy earth-gullied roads that are almost impassable during the rainy season due to sludge, it is not easily accessible by conventional motor vehicle ambulances.

In the absence of an ambulance, patients — especially women in labor — have challenges accessing the nearest health facility. In the Nsanje district, women travel up to 16 kilometers on foot to access the nearest hospital and in some cases end up giving birth on the way.

“I almost gave birth to my second-born son on the way to the maternity [ward],” Nyang’ombe said. “I was however lucky that in the nearby village where the labor reached its peak they had a bicycle ambulance and a volunteer carried me to the hospital on the ambulance.”

The unavailability of traditional ambulances has resulted in many women that have maternal complications dying in transit to referral hospitals. Women and Children First estimates that 1 in 150 women in the country dies in pregnancy and childbirth. And a delayed referral to a health facility due to unavailability of transport contributes to this high statistic.

The organization together with MaiKhanda, a local NGO, has set up women’s health groups in Malawi that have adopted the use of bicycle ambulances to transport pregnant mothers to a health facility.

Annemijn Sondaal, programs manager at Women and Children First, told Devex that using a local solutions approach, the women’s health groups identified hemorrhage as one of the biggest problems that pregnant women face, and the bicycle ambulances were recommended as a unique solution.

“They themselves came up with the idea of making a bicycle ambulance and as a group gathered the resources necessary to make these ambulances,” Sondaal said.

She said data on the women’s health group project shows a 14% increase in delivery with a skilled birth attendant, over 91 lives saved and reduced maternal and neonatal case fatality rates in the first two years of the project. There has also been a 13% increase in mothers seeking postnatal care within 2 days after giving birth and an 83% increase in improved service quality on a postpartum hemorrhage.

“Our evidence shows that globally the work of women’s health groups, implementing solutions such as the bicycle ambulance, can lead to a 49% reduction in maternal mortality rates,” she said.

The bicycle ambulances which are also being manufactured and distributed in southern and central Malawi by Sakaramenta, another social enterprise, have proven to be a worthwhile investment. Ricky Mwenyewe bicycle ambulance monitoring officer at Sakaramenta said the ambulance can reduce a 90-minute walk to a 15-minute journey and make the difference between life and death for a mother facing complications in pregnancy and childbirth.

In addition to positive health outcomes for pregnant women, there is also a cost-benefit to switching from traditional ambulances. A 2001 study on motorcycle ambulances in Malawi found that at an annual operating cost of $508, motorcycle ambulances reduced the median referral delay by 2 to 4.5 hours, or 35% to 76%, and that motorcycle ambulances were almost 24 times cheaper to operate than a car ambulance.

In Tanzania, the U.S. Agency for International Development and the Vodafone Foundation are making use of “ambulance taxis” as part of their mobilizing maternal health initiative. Under the arrangement, women in labor call a toll-free number that connects them to a network of trained registered taxi drivers who can transport them to a health facility at no cost.

In the last five years, the initiative has helped to reduce regional maternal mortality by 27%, by transporting 8,800 high-risk women and 1,950 newborn children to the hospital.