What do you do when having gone into labour, there are complications and the nearest clinic is 30 kilometres away, roads are in poor condition and means of transport are scarce or non existent?
Access to health care –particularly for pregnant women- is one of the main challenges in transport in general and in rural transport in particular. In the rural context we actually don’t know the full extent of the relationship between transport and (maternal) health. Yes obstructed labour due to obstructed transport is certainly a cause for high maternal mortality rates as the starting question implies but…. there are many others. Exploring these issues and links are at the core of the Mobility and Health programme, an international networked research programme carried out in 24 countries in Asia, Africa and Latin America to help increase the overall knowledge base. This month’s blog explores some of the preliminary findings the researchers have shared through www.mobilityandhealth.org
In Nepal the District Roads Support Programme (DRSP), an SDC-funded programme aiming to improve the district road network is researching the effects of restricted access on maternal health in rural remote and mountainous areas. In general, Nepal is a mountainous country, with an average poverty level of 42%. Due to inaccessible terrain and lack of transport infrastructure, poor people find access to health services very difficult and expensive. A number of programmes are addressing these issues, from the physical access and the health perspective, although not in an interdisciplinary way. Maternal mortality comprises a large percentage of deaths in Nepal and recent research suggests that this situation is exacerbated by restricted access.
The team led by Binjwala Shrestha found many women have experienced problems with access to a health centre. The story of Ansu (name has been changed for privacy reasons), a 40-year old mother of five who delivered her last baby at home is particularly telling. After a complicated birth the local health worker was called but due to an inaccessible road (poor condition and rainy season) and lack of transport, she could not come until the next morning. Sadly this proved too late for mother and baby. Ironically the house is only 10 minutes from the nearest road and 30 minutes from the nearest community.
In South Africa a team led by Mac Mashiri is assessing how to improve access to health care by researching the role of home-based care services in strengthening rural health care delivery. In Mpumalanga Province in the north they are undertaking field work by working with communities and home-based health care providers who are focusing their attention on families affected by HIV/AIDS. While interviewing one of the nurses the following complication was shared: “…When it is raining, the road to the clinic is so bad – so slippery that people coming to the clinic are forced to disembark from the taxi and walk the rest of the way to the clinic because they fear that the taxi can skid and cause a fatal accident…” This does restrict people’s access while seeking health services.
Finally in northern Peru Diogenes Ampan and his team members are collaboratively working on the role of river transport in accessing conventional and traditional health services in the rural rainforest in Cenepa. A big part of their methodology consists of organising participatory workshops with indigenous communities to sensitise them on the relationship between rural access and overall health care and explore how they can overcome some of these challenges. Although the research is only half way and final results will be published in early 2008 some of the preliminary findings are already worth sharing. In the Cenepa area the main problem with transport and health is the lack of access to fuel for emergency transport to health clinics. Many people do have access to boats but fuel for the motors is scarce and expensive. This applies to the extension workers of the various health posts as well as the remote communities, meaning that quite a few people are dependent on dugout canoes for their journey to the posts. This significantly delays their journey as well as increases the risk of drowning on the treacherous river rapids.
These snapshots drawn from the ongoing Mobility and Health research reveal real experiences relating to transport and health care. We strongly encourage you to visit www.mobilityandhealth.org for more details and contact me if you have any questions and/or comments!
See you next month!
PS If you are interested in writing a blog entry sharing your experiences in rural transport please contact me!
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