Uganda ambulance initiative Kenya's governors could learn from

By Stephen Mburu in Nairobi and
Daniel Edyegu and Ronald Ssekandi, in Mbale
The Ugandan government and a European health service provider have joined hands to help the sick in rural areas access health centres for urgent attention.
The motorcycle ambulance initiative in Uganda's Mbale district is a health lesson Kenya’s governors could borrow with a view to helping improve service delivery to residents of their counties.

Accessing health care in mountainous eastern Uganda can be difficult, especially for pregnant mothers who are about to give birth. Mothers who are in areas that cannot be accessed by vehicles have to walk long distances to the maternity centres to give birth.
In an emergency case, the mother risks losing her baby or her life. Many expectant mothers stay at home to be nursed by elderly women or traditional birth attendants who may not have all the required skills to help a woman deliver.
   However, Uganda public health officials together with  the Partnership Overseas Networking Trust (PONT), associated with the  Welsh Ambulance Services of UK, have come up with a new initiative: motorcycle ambulances. Information on the Welsh Ambulance Services website says PONT, a charitable organisation based in Pontypridd town, was started in 2002. The two towns twined in 2009 for a long-term partnership that seeks to "Make Poverty History" in the eastern Ugandan districts of Mbale, Manafwa and Bududa. Mbale region has a population of about 760,000 people.
This direct local link, the website says, has since enabled PONT  to make the partnership much more personal and easier for the people to identify with. Welsh Ambulance Service frontline staff were invited by PONT to visit Mbale to explore the possibility of setting up an Emergency Ambulance Service for the region. The partnership involved first nine Welsh Ambulance Service staff travelling to Mbale where they trained 60 local health workers.


The initiative has since paid dividends as health officials in Mbale region now say  the introduction of three-wheeler ambulances has  since helped reduce maternal deaths during child delivery, as more expectant mothers could be ferried to deliver at local health centres.
   The ambulance is a high-powered multi-terrain motorbike with a sidecar stretcher for a patient. There is also space for emergency on-site medical supplies and room to carry a health worker out to remote communities.
   The ambulances are stationed at health centres, and health workers or community members are trained to ride and maintain them. The motorcycles  are able to navigate difficult road surfaces, especially during rainy seasons, than car ambulances.
   John Baptist Waniaye, the Mbale district health officer told Xinhua in an interview that the region, being mountainous, the ambulances were allocated to far-to-reach sub counties.
   Waniaye said unlike in the past where most expectant mothers in the rural areas would deliver at home with the help of either elderly women or traditional birth attendants, such mothers would now deliver at health centres.
   "In Mbale district, a total of 11,000 women delivered at the government health units last year, an increment of 39 per cent of the previous year. Coupled with bad roads and steep terrain, there are areas in this region that become inaccessible to vehicles, especially during heavy rains. These motorcycle ambulances can access nearly any area," Waniaye said.
He said the motorcycle ambulances have partly bridged the gap as the district has only two double cabin pick-up ambulances, which cannot serve the whole district.
Roslin Nandaula, a midwife at the local Busiu Health Centre, said statistics at the health unit for the first quarter of the year indicate that 68 mothers delivered at the unit in January, 72 in February and 78 in March.
   "Mothers tend to deliver at odd hours, like at night. These ambulances operate 24 hours which eases delivery to health units," she said, adding that in the rural communities mothers  deliver in unhygienic conditions, for instance, tying the umbilical cord of the newborn baby with a banana fibre, which increases the risk of infection.
   "Delivery in health unit minimizes these risks, including mother-to-child transmission of HIV/Aids," Nandaula said.

   The seven tricycles were introduced two years ago by PONT.
  Uganda's current maternal mortality rate is at 435 per 100,000 live births, according to ministry of health statistics.
   The UN Millennium Development Goal (MDG) aims at reducing by two-thirds, between 1990 and 2015, the under five years old mortality rate, from 93 children of every 1,000 births to 31.

   MDG Five amims at improving maternal health, including reducing by three-fourths the maternal mortality ratio and achieve universal access to reproductive health.
   A study which examined whether motorcycle ambulances placed at rural health centers in Malawi were more effective than car ambulances, found that the bikes reduced referral times between health units and hospitals by between two and more than four hours.
   "Depending on the site, median referral delay was reduced by 2 to 4.5 hours. Purchase price of a motorcycle ambulance was 19 times cheaper than for a car ambulance. Annual operating costs were 508 US dollars, which was almost 24 times cheaper than for a car ambulance," said the study, which was published in the International Journal of Gynecology and Obstetrics in 2008.
   It concluded that in resource-poor countries, motorcycle ambulances at rural health centers are a useful means of referral for emergency obstetric care and a relatively cheap option for the health sector.
   The researchers, however, added that the motorbikes did not eliminate the need for car ambulances altogether, and the reluctance of drivers to ride at night and the cost of, and access to fuel were raised as possible obstacles to the use of motorbike ambulances.  (Xinhua)