Emergency Transport Scheme (ETS) in Nasarawa State, Nigeria – Technical Brief

According to the World Bank (2017), Nigeria has the fourth worst estimated maternal mortality rate (MMR) in the world of 917 deaths per 100,000 live births. Nasarawa State, located in North Central Nigeria, has been estimated to have a maternal mortality rate (MMR) of 1,000 deaths per 100,000 live births. Among the many factors contributing to the alarming MMR figures, transport availability and affordability are some of the key barriers to safe motherhood in Nasarawa. To address these constraints, Transaid established an Emergency Transport Scheme (ETS) in two Local Government Authorities (LGA) in 2016-2017 that aimed to bridge the gap in available and affordable transport solutions for women seeking institutional deliveries.

Programmatic operations involved the training of ETS volunteer drivers, equipping them with the skills to safely transport women in need to a health facility in the six Local Government Authorities (LGA). Building on the learnings from this pilot intervention, in partnership with the National Union of Road Transport Workers (NURTW), the Ministry of Women Affairs and the Ministry of Health in Nasarawa State, ETS activities were expanded into four new LGAs in November 2017.

 

To read the full technical brief, click below.

Emergency Transport Scheme (ETS) in Adamawa State, Nigeria – Technical Brief

In July 2013, Transaid, in partnership with Nigerian NGO, Society for Family Health (SFH), received funding from Comic Relief to deliver a five-year programme aimed at improving access to maternal health services for rural communities in Adamawa State. Nigeria had a Maternal Mortality Ratio (MMR) of 576 deaths per 100,000[1] live births in 2013, one of the highest in sub-Saharan Africa.

Based on lessons learned from previous programmes including PRRINN-MNCH and the Emergency Transport Scheme (ETS) programme in Gombe State, Transaid implemented an ETS in Adamawa State in collaboration with the National Union of Road Transport Workers (NURTW). This programme targeted communities living in 16 Local Government Areas (LGAs), constituting almost 3.1 million people[2], utilising the NURTW’s influence and capacity in coordinating the activities of taxi drivers nationwide.

 

To read the full technical brief, click below.

Health Facility Study Report – Adamawa State Emergency Transport Scheme (ETS) Programme

The Comic Relief funded Emergency Transport Scheme (ETS) programme ran in Adamawa State, North East Nigeria, for a five-year period between 2013 and 2018. It focused on reducing the health care access gap for pregnant women in rural communities during delivery or maternal complications, through safe and affordable transport.

Given the limited evidence-based guidance for practitioners and policy-makers in both the health and transport sectors on how best to reduce the negative impact of lack of transport on Africa’s high maternal mortality rates, there is scope for this report to add to global learning and inform decision-makers.

The Adamawa State ETS programme Health Facility Study Report outlines the findings from an investigation to determine if and how the use of ETS correlates to a woman’s health condition upon arrival at a health facility during delivery or a maternal complication.

To read this report, please click below.

Emergency Transport Scheme (ETS) User Survey Report – Adamawa State ETS programme

The Emergency Transport Scheme programme ran in Adamawa State, North East Nigeria, for a five-year period between 2013 and 2018 and was funded by Comic Relief. This focused on bridging the gap in access to health care for pregnant women in rural communities during delivery or maternal complications through providing safe, affordable transport. The programme was implemented by Transaid and Society for Family Health (SFH) in collaboration with the National Union of Road Transport Workers (NURTW), the Adamawa State Government and local communities.

The ETS User Survey Report presents the findings from the Adamawa State ETS programme and gathered both qualitative and quantitative data, which are invaluable in building understanding of the reasons behind ETS users’ choices to make use of the emergency transport scheme. The survey was conducted in March 2017 and gathered data from 150 women on their health and transport seeking behaviour.

To read this report, please click below.

H12. Emergency Transport Scheme user survey form

This tool is to be used to gather qualitative and quantitative data from users of an Emergency Transport Scheme. The tool gathers data such as costs, timings and information on health seeking behaviours to inform the intervention as well as to provide information for effective project management.

They have been used in the five year Emergency Transport Scheme (ETS) project which ended in 2018 and aimed to contribute to reducing maternal mortality in Adamawa State, Northern Nigeria. The project partnered with the National Union of Road Transport Workers’ (NURTW) commercial taxi drivers who were trained to provide an affordable, accessible, safe and timely emergency transport service for pregnant women in labour or for those experiencing complications during their pregnancy.

Click below to download this tool.

H33. Emergency Transport Scheme Needs Assessment form [NURTW]

The assessment is a way to validate assumptions made during the programme design. It is also an opportunity to learn more about the area and anything which may influence the implementation of the programme

Transaid launched the Nasarawa State Emergency Transport Scheme from a pilot programme to a scale up programme covering six Local Government Areas (LGAs). This scheme will work closely with existing taxi drivers, the National Union of Road Transport Workers (NURTW) and the government to provide affordable, accessible, safe and timely transport for pregnant women living in rural areas to a health facility.

Click below to download this form.

H34. Emergency Transport Scheme Needs Assessment form [Women in the community]

This assessment is a way to validate assumptions made during the programme design. It is also an opportunity to learn more about the area, from the women who live there, and anything which may influence the implementation of the programme. This tool was originally used during an assessment process for an Emergency Transport Scheme (ETS) in Nasarawa, Nigeria.

Transaid launched the Nasarawa State Emergency Transport Scheme from a pilot programme to a scale up programme covering six Local Government Areas (LGAs). This scheme will work closely with existing taxi drivers, the National Union of Road Transport Workers (NURTW) and the government to provide affordable, accessible, safe and timely transport for pregnant women living in rural areas to a health facility.

Click below to download this form.

Maternal health and transport Questionnaire

This tool is to be used for gathering information from women regarding birth, maternal emergencies, danger signs and transport. It is used for gathering information to understand the process a woman and her family go through during pregnancy, delivery and emergencies in regard to what actions are taken if any, including transport. This tool can be used to gather data for a baseline, midline and endline study. It can also be used as an assessment tool to inform a design process around emergency transport.

This tool was initially designed for and used during Transaid’s Emergency Transport Scheme (ETS) in northern Nigeria. In 2013, Transaid was awarded with the five-year grant from Comic Relief to set up the Emergency Transport Scheme in Adamawa State. The ETS encourages local taxi drivers from the National Union of Road Transport Workers (NURTW) to transport women to health centres free of charge or at minimal cost when they are faced with complications. To read more about this programme, please click here and to for the tool, please see link below.

 

Transport Awareness Questionnaire

This tool is to be used for gathering information from heads of households to determine the current socio-economic status of the household, as well as some other basic information on transport and communications during a maternal emergency. This tool can be used to gather data for a baseline, midline and endline study. It can also be used as an assessment tool to inform a design process around emergency transport.

This tool was initially designed for and used during Transaid’s Emergency Transport Scheme (ETS) in northern Nigeria. In 2013, Transaid was awarded with the five-year grant from Comic Relief to set up the Emergency Transport Scheme in Adamawa State. The ETS encourages local taxi drivers from the National Union of Road Transport Workers (NURTW) to transport women to health centres free of charge or at minimal cost when they are faced with complications. To read more about this programme, please click here and to for the tool, please see link below.

Improving iSC performance through outsourcing – Considerations for using third-party service providers to increase innovation, capacity and efficiency

Development partners and donors have encouraged and incentivized governments in developing countries to explore ways of working with third-party service suppliers to reduce costs and increase service delivery capacity. The distribution of vaccines and medicines has for a long time shown demand for outsourcing but public health systems have struggled to develop the expertise and capital assets necessary to manage such ventures.

Existing transport and logistics capacity within public health systems, in particular, is well documented as being insufficient to support existing, let alone future immunization needs. Today, a number of countries are contracting party logistics providers (3PLs) to supplement the in-house distribution operations of public health systems. This commentary reflects on recent, leading examples of outsourcing initiatives to address critical gaps in transport and logistics

H28. Emergency Transport Scheme Training Manual

This training manual was originally used as part of an Emergency Transport Scheme (ETS) in Northern Nigeria. The ETS aims to provide affordable, accessible, safe and timely means of transport for pregnant women during labour or obstetric emergencies by taking them to the nearest health facility using an existing, functioning and well-organised transport system provided by volunteer drivers of the National Union of Road Transport Workers (NURTW). This training manual was developed as part of a programme called ‘Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal, Newborn and Child Health Initiative’ (PRRINN-MNCH) by a consortium comprised of the National Union of Road Transport Workers (NURTW), PRRINN/Health Partners International (HPI) and Transaid and approved by the National President of NURTW in 2012. The purpose of this training manual is to develop the knowledge and skills of ETS drivers so that they can actively and effectively contribute to reduce the delay that maternal emergencies face in accessing transportation to health facilities. It covers modules such as; maternal danger signs in pregnancy and delivery, how to lift and handle a pregnant woman, the importance of providing timely transportation and agreeing the basic costs for transportation, amongst others. There are other versions of this manual in circulation. Transaid wishes to acknowledge the valuable contributions of the following in the development of this training manual: Dr. Emmanuel Sokpo (PRRINN-MNCH Health Systems Adviser), Dr. Fatima Adamu (PRRINN-MNCH Community Engagement Adviser), Miniratu Soyoola (HPI), Ibrahim Ahmad (NURTW), Gary Forster (Transaid Chief Executive), Cathy Green (HPI) and Balogun, Ismaila Aliyu (Transaid National Project Manager & Pioneer Nigerian ETS Lead Consultant). 

Please contact Transaid at info@transaid.org for further technical advice if you are planning to use this manual.