Designing a referral scheme for maternal health in Kenya

In March 2015, Transaid was asked to provide technical support to the MANI project (Maternal and Newborn Health Improvement project in Bungoma County, Kenya) to assess transport barriers to maternal health services as well as design an appropriate referral system to facilitate the transfer of pregnant women from their homes to health facilities. The MANI project is being delivered by a consortium of organisations and other partners including: Marie Stopes International, Options Consultancy Services, AMREF, CARE, the Institute of Health Policy, Management and Research, KPMG IDAS, MannionDaniels, and the Population Council.


The aim of the MANI project is to strengthen core health systems in Bungoma County in Western Kenya and to increase the survival rate of mothers and newborns by enabling poor women to access affordable and quality health services throughout the county.

During a one month project Transaid conducted a transport mapping exercise in a sample of communities in Bungoma to confirm what types of transport are available and what the obstacles to pregnant women using them are. This was followed by a review and strengthening of the initial design of the project that proposed a transport voucher scheme. Transaid also made recommendations for potential innovative transport solutions to be funded through the challenge fund in Bungoma and other similar counties in Kenya.


A combination of qualitative and quantitative data was collected through stakeholder meetings, focus group discussions and individual interviews with key stakeholders. This led to a recommendation to establish an Emergency Transport Scheme (ETS) which would reduce the cost and delay associated with organising transport from the community to the health facility.

The ETS will commence with the recruitment of Boda Boda riders (motorcycle taxis) from each identified Community Unit. Recruitment will be undertaken by a group consisting of community members, Community Health Volunteers (CHVs), Village Elders and local Chiefs. Only riders of good standing, who own their own motorcycle, a license, a phone and helmet will be eligible. With support, these riders will develop strong linkages between communities and health facilities; working with CHVs, ETS riders will become aware of who the pregnant women are, where they live, and when they are expecting to give birth. Riders will get to know the woman and her family so that, if at the time of labour the woman needs to be transported on credit, the ETS rider will do so knowing that he will be able to collect funds later. CHVs will be the liaison person between the pregnant woman, the ETS rider and the health facility.


With agreement from the riders, communities and the riders’ representative association, prices for transporting pregnant women will be fixed at a rate as close as possible to the market rate. A day rate and a night rate will be agreed in order to cease any exploitative pricing by Boda Boda riders for transporting pregnant women. Phone numbers of ETS riders will be shared with communities, and will be available at dispensaries, health facilities and will also be carried by CHVs.


For selected communities in specific Community Units, a Tapered Voucher Scheme (TVS) will be implemented. The TVS will provide vouchers to pregnant women and, for the first 12 months, will cover the whole cost of referral from their community to the health facility. For the second 12 month period the vouchers will cover 50% of the cost of using the ETS to reach a health facility. Frontline SMS (or a similar system) can be used as an SMS platform for managing and verifying the voucher system.


Transaid has a long experience in managing community transport systems. Similar programmes operated by Transaid in Uganda and Nigeria have already highlighted the potential for establishing formalised referral schemes using private sector transport resources. In Kenya, the impact of the proposed approach is expected to achieve a reduction in maternal and stillbirth/neonatal deaths as a result of delays in reaching health facilities.

Transaid’s More MAMaZ programme showcased on national television in Comic Relief build-up

Last night, Monday 2 March, a major Transaid project, the MORE MAMaZ programme, was showcased on national television during BBC Two’s Let’s Play Darts for Comic Relief, as part of the build-up to Comic Relief, taking place on Friday 13th March 2015.

Recipient of a £1.83million grant from Comic Relief, Transaid’s MORE MAMaZ programme (Mobilising Access to Maternal Health Services in Zambia) aims to increase healthcare facility attendance rates among expectant mothers and newborn babies in remote regions of Zambia.

The MORE MAMaZ programme builds on the success of the original MAMaZ initiative run between 2010 and 2013. Implemented in association with Health Partners International (HPI) and Zambian organisations Disacare and Development Data, the project works towards eliminating barriers to access to health facilities in five remote regions including Chama, Mkushi, Mongu, Serenje and Chitambo.

The programme creates projects such as the Emergency Transport Scheme, which trains local community volunteers in areas where emergency transport is unavailable or unaffordable to drive bicycle ambulances. These can then be used to transport women in labour to the nearest health facility at little or no cost.

Other elements of the programme include savings schemes, food banks and a network of mothers’ helpers, all contributing to make access to necessary healthcare possible for those living in isolated villages.

Gary Forster, CEO of Transaid says: “The original MAMaZ programme was hugely successful in creating a viable transport system, resulting in increased numbers of women delivering their children in hospitals or clinics.

“We’re grateful to Comic Relief for providing us with the funds to be able to expand the project and we’re proud that we’ve been able to share the programme’s success with the nation, highlighting the serious issues communities in remote parts of the world face in accessing vital healthcare,” he adds.

The Transaid video was broadcast at the 25 minute mark in the BBC’s Let’s Play Darts for Comic Relief programme. To watch the video please click here.

Transaid to launch driver training initiative in Uganda

International development charity Transaid is expanding its successful Professional Driver Training Project (PDTP) into its third country, after the programme successfully increased standards of commercial driver training methods in Zambia and Tanzania.

The initial 12 month programme will be rolled out in Uganda – a country which has one of the highest road traffic fatality rates – with an estimated 28.9 road traffic deaths per 100,000 population, compared to 3.7 in the UK*.

Transaid will be working with the ‘Safe Way, Right Way’ Partnership and Central Corridor Transit Transport Facilitation Agency to implement the scheme during the rest of 2014, and will begin by conducting PCV (Passenger Carrying Vehicle) training of driver trainers in Kampala, followed by HGV training.

Transaid is ideally placed to conduct this type of training having supported the development of the professional driver training at the Industrial Training Centre in Zambia since 2008 and the National Institute of Transport in Tanzania since 2010. Traditionally driver training in Africa has been mainly theory based, but through the PDTP Transaid has increased the ratio of hands-on practical training, essential for developing safer drivers. The PDTP is supported by a management board consisting of representatives from the UK transport companies who contribute through secondment of volunteers, donation of training vehicles and providing strategic advice.

Gary Forster, Transaid’s Chief Executive, says: “The PDTP has been a hugely effective project in Zambia and Tanzania and Transaid has been at the forefront of changing the driving habits of literally thousands of commercial vehicle drivers. We hope to mirror the achievements of the project from those countries in Uganda.

“Key to the successful implementation of our projects is our fantastic team of professional volunteers and corporate partners who have been supporting the Professional Driver Training Project for the last six years. We gladly welcome any businesses in the transport industry here in the UK who are interested in getting involved.”

Transaid’s Project Manager for Road Safety Neil Rettie, adds: “Launching the scheme in Uganda is a major undertaking, but is a key step to creating safer roads in the country. Uganda has one of the highest road crash death rates in Africa, so projects like the PDTP are vital to increase education and awareness surrounding road safety which ultimately saves lives.


Needs Assessment in Western Uganda

Transaid conducted a needs assessment which looks at the need for an Emergency Transport Scheme (ETS) in Western districts of Uganda. The project is funded by the American pharmaceutical company Merck and aims to improve understanding about the challenges that pregnant women have in accessing maternal healthcare and expand women’s access to promising solutions for postpartum hemorrhage (PPH), infection and pre-eclampsia).

Many pregnant women in the rural areas of Uganda give birth to their babies at home without the proper health care needed. Combined, PPH, infection and pre-eclampsia, account for an estimated 52% of maternal deaths in Uganda. A primary constraint to rural communities accessing healthcare   is the availability and affordability of local transport services. Transaid has extensive experience in identifying, championing and implementing local transport solutions for rural communities across Africa, and due to this, was approached to take on this project. The assessments to date have looked at two districts, Hoima and Mubende, and will extend to 2 more districts in the 2nd year of the project. Initial research was done in Mubende.

The needs assessments were carried out over two weeks through face to face interviews and village based focus group meetings. The findings were analysed and then recommendations were determined for the way forward. Firstly, Transaid assessed the health clinics in the area gathering details about healthcare costs, catchment areas and their perspective on the transport challenges of people in their catchment areas. Then focus group meetings took place in villages 4-24 km away from the clinics. In this research the discussions were aimed at getting an overall picture relating to transport availability and affordability as well as establishing what the appropriate interventions might be. The focus groups were also used to gauge interest in intervention options.

During the assessment it was found that women would prefer to have their babies in the clinic but did not have finances to pay for transport or transport was not affordable.  Many women try to save some money to pay for transport at the expected time of birth but domestic and unexpected needs usually deplete these savings over time, leaving households little or no savings to deal with emergencies.  Furthermore, local motorcycle taxi (boda boda) operators often take advantage of emergency situation and charge pregnant women needing to get to the clinic at a higher rate. Based on this data, Transaid plans to implement solutions tailored to each of the target districts based on their specific needs revealed in our research.

Transaid is planning to implement the solutions in November and December 2013 as well as carry out the assessments for the expansion of the project into two further districts.

Increasing mobility of Community Health Workers in Madagascar

On the large, remote, southern African island of Madagascar its hard-to-reach Malagasy communities endure high endemic poverty and a recent history of civil strife. In 2011 Transaid partnered with JSI Training and Research Institute, Inc. (JSI) and The Manoff Group in a major USAID funded project, to reach out to communities in northern and western parts of the island.

The MAHEFA project answers to the country’s basic community health needs, in line with the National Community Health Policy which aims to bring essential health services as close to the patient as possible. MAHEFA aims to support local people to manage their own provision and access to maternal, child and other essential community health care. It is vital that local community health workers (CHWs) have good access to the populations they work with.

Besides regularly visiting patients, the CHWs must keep their local facilities stocked up with essential drugs and other medical commodities, provide health promotion and community sensitisation activities, take part in local meetings, and get back home in time to write up their reports. They must do this every day. For CHWs to serve their communities well may mean daily travel of 20 to 30 kilometres, often across difficult terrain. This is typically done on foot, taking many hours simply to reach a village. They then struggle to complete all their health-critical services and tasks before it gets dark and the journey back home becomes dangerous.

Since 2013, MAHEFA has distributed bicycles to CHWs and provided training on safe riding, maintenance and repair. Clear evidence is now emerging of the differences these bicycles make to the quality of health service provision and to CHW satisfaction. CHWs using MAHEFA bicycles cover greater areas and carry out all community health activities, including sensitisation and restocking health commodities. They are not late for meetings and they submit timely reports.

Gabriel is a CHW from the isolated district of Mahabo. Since receiving his MAHEFA bicycle he visits up to 10 homes each day. Before, he’d manage to reach just three houses in one day. His visits are also longer since it takes him less time to get from and back to his home. In using his bicycle to spend more time with patients, Gabriel has improved the quality of the CHW services he can offer. He is also happy that he can repair his own tyre punctures.

The overall number of household visits by CHWs has increased since the MAHEFA bicycles were introduced. This observation is confirmed by village and community health leaders, and through the CHWs own logbooks. There has been a rise in key health promoting activities, such as in relation to maternal and child health. The CHWs also report increased satisfaction because the bicycle provision significantly decreases their work travel time meaning more time for themselves in their own personal lives. It is particularly important that they stay motivated to carry out their crucial health care work.

MAHEFA delivered over 300 bicycles to CHWs in 2013. Many more Malagasy communities are thus significantly better served with basic health treatment, supplies and advice than they could have been two years ago. During the current 2014 project year a further 700 bicycles at least are planned for distribution, together with appropriate training.