The Problem
In many developing countries women die during childbirth for lack of skilled health care attendants because they are unable to reach health facilities. Maternal mortality in Afghanistan is the second highest in the world, and with an average of 7.2 babies per woman and is the leading cause of death in women of reproductive age.

HealthProm has been working with local partners to improve uptake of maternity services and newborn care by women living in the villages. The majority of births are meant to take place in health centres, but in rural areas 90% still take place in villages with no skilled care. This is largely because women and their families fail to recognise the need for the midwife early enough and because accessing healthcare in the mountainous areas is so difficult.

The Process
HealthProm (link) approached Transaid to seek assistance in the development of a solution for ensuring pregnant women could access health facilities at time of birth. Transaid sought the advice of Olivia Comberti, an appropriate technology engineer, formerly with Developing Technologies. 

Working with Transaid and HealthProm, Olivia developed a number of designs for a variety of methods to move pregnant women including traditional stretchers, wheeled stretchers, and sleds pulled by a horse or donkey.  Discussions were held during the development process regarding localisation, sustainability and availability of materials in Afghanistan to produce the right methods of transportation.  Best practice input was also gathered from mountain rescue teams in the UK.

Transaid provided advice and expertise on rural access development projects.  A Participatory Rural Access Survey was developed to help local HealthProm facilitators in Afghanistan discuss access issues with key stakeholders on the ground.  This helped facilitate the sharing of negative experiences of women who had struggled to reach health facilities and problem solving activities to overcome these challenges. Transaid also advised on the establishment of men’s voluntary groups to support the movement of women during emergencies. 

Transaid has committed to fund the manufacture in-country of whichever design is finally chosen.

Partners
HealthProm, Developing Technologies

The Impact
This project will help to reduce the delay and cost of transportation within the region to enable better access for women to local health facilities.