Article: Reflecting on the changing landscape of Emergency Transport Systems (ETS) in rural Zambia, a year after the conclusion of the MAM at Scale programme

In Zambia, through the MAMaZ Against Malaria (MAM) and MAMaZ Against Malaria at Scale (MAM@Scale) projects, Transaid delivered its largest scale-up ETS intervention to date which has reached nearly one million community members since its inception in 2017. Trained Community Health Volunteers (CHV) were instrumental in the running of a community-based ETS consisting of 70 bicycle ambulances. In an effort to prevent mortality in children under six due to severe malaria, the project sought to tackle the practical barriers and delays in accessing healthcare services at the primary healthcare level.

The MAM@Scale project shows the value of investing in rural mobility. When interventions are implemented in a manner that generates community ownership and are responsive to community needs, the benefits are far-reaching and sustainable. This approach changes the way communities are able to access vital health services and for health care to become people-centred as envisioned in the Sustainable Development Goals. At the very least, it is an incremental step in the right direction towards achieving universal access.

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Report: MAM@Scale Endline Survey Report

The MAM@Scale project sought to support the scale-up of an evidence-based intervention that aimed at increasing access of hard-to-reach communities to effective treatment for severe malaria in high malaria burden settings. The project was implemented in phases, i.e., Transition to Scale 2 (TTS2) which was implemented in two demonstration districts and three National Scale Up (NSU) districts and TTS3 which was implemented in the five TTS2 districts and another additional five NSU districts. The endline was carried out in selected project areas during the months of October and November 2021 to determine the contribution of the project towards increasing the access of hard-to-reach communities to effective treatment for severe malaria in high malaria burden settings. Findings were compared to those of the baseline survey (February 2019) and the midline survey (July 2020).

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Webinar slides: Next stop – healthcare: Improving community access to emergency transport using publicly available transport

Transaid and JSI Research & Training Institute, Inc. (JSI) have hosted a webinar on 10th March 2022, to share the impact and key learnings of a collaboration between local transport cooperatives and rural communities to support access to emergency transport as a part of USAID funded ‘Community Capacity for Health Program’ (CCHP).

In Madagascar, the mortality rates for mothers and children under five (CU5) were 335 and 51 per 100,000 in 2019, respectively. Delays in seeking access to quality care are a key contributor to maternal and under-five mortality and inadequate access to transport has been identified as one of the three major reasons for delays in access to health services.

This webinar discussed the impact of a collaboration between transport cooperatives and communities to expand community emergency transport networks between rural communities and health centres and hospitals, supporting community members to more easily and affordably access health care. The webinar shared key learnings from the project, highlight how the partnership was successfully integrated and explored the opportunities for scaling the approach.

Speakers included:

  • Dr Yvette Ribaira: Chief of Party, Madagascar Community Capacity for Health Program
  • Dr Izaka Rabeson: Specialist in Community Health Funding and Emergency Transportation
  • Mahery Ramanantoanina: Reguibak BCC and Mobilisation Officer DIANA
  • Kim van der Weijde: Project Manger, Transaid

The USAID Community Capacity for Health Program—known in Madagascar as Mahefa Miaraka was a five-year (2016–2021) community-based integrated health program funded by the United States Agency for International Development (USAID). The Program was a collaborative effort among the Ministry of Public Health (MOPH), USAID, and JSI Research & Training Institute, Inc. (JSI).

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Evidence brief: Scaling up Safe Motherhood Action Groups in Zambia

The Mobilising Access to Maternal Health Services in Zambia programme (MAMaZ) and its successor programme, MORE MAMaZ, supported the scaling up of the national Safe Motherhood Action Groups (SMAG) initiative between 2010 and 2016. Government efforts to roll SMAG activities out to new areas (horizontal scale-up) and to build institutional ownership, thereby placing the initiative on a sustainable footing (vertical scale-up) were supported. These scaling up experiences are highly relevant in a context where current global health policy gives high priority to accelerated implementation of evidence-based initiatives to ensure the survival of every newborn, mother and child.

This brief sets out to capture the changes that have occurred in communities where Safe Motherhood Action Groups (SMAGs) are operational.

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Evidence brief: Addressing Gender-based Violence through Safe Motherhood Action Groups in Zambia

The term gender-based violence (GBV) includes any form of violence against women. Despite a favourable policy environment with the introduction of the anti-GBV law, GBV statistics in Zambia remain high. Of women aged 15-49 years, 43% have experienced physical violence at some point in their lives, 37% in the previous 12 months. Moreover, 17% of women and girls have experienced sexual violence, and 10% have experienced violence while pregnant (2014 Zambia Demographic and Health Survey).

Continuing the work of a predecessor programme, MAMaZ (2010-2013), which was funded by UK aid from the UK government, the Comic Relief-funded MORE MAMaZ programme (2014-2016) took steps to integrate a focus on GBV into the training of Safe Motherhood Action Group (SMAG) volunteers.

The MORE MAMaZ GBV interventions resulted in transformative change for women. Intervention communities reported a very significant reduction in GBV. Some communities perceived that GBV had been eliminated, with these changes attributed to the work of the SMAG volunteers.

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Evidence brief: Key Results from MAMaZ Against Malaria – A Pilot Project Focused on Increasing Rural Communities’ Access to Rectal Artesunate

According to Zambia’s national Health Management Information
System (HMIS), a reported 1,851 Zambians died of malaria in
2016. Many other malaria deaths occur at community level and
go unrecorded. Reported malaria cases increased between 2015-
2016. If Zambia is to achieve the global target of a 40% reduction
in malaria incidence by 2020, a priority focus on areas of highest
mortality, including severe malaria in young children, will be

This evidence brief presents the key results from the MAMaZ Against Malaria (MAM) project, a pilot focused on increasing rural communities’ access to rectal artesunate.

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Webinar slides: Scaling up RAS in Zambia. Results from the MAM@Scale programme

In this webinar, held on 01.02.2022, the project team and partners presented the final results from MAMaZ Against Malaria at Scale, a project that supported the roll-out of quality assured pre-referral RAS in Zambia.

The webinar traced how the project scaled up from a small single-district pilot in 2017 to a much larger-scale initiative that was implemented in ten districts by 2021. Experience and lessons learned along the way were shared by the team. This webinar was also an opportunity to hear the plans for further national scale-up within Zambia.

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Evidence Brief: Scaling up rectal artesunate in a community-based initiative in Zambia. Final results from MAM@Scale

As the global development agenda converges around the Sustainable Development Goals (SDGs) and aims for Universal Health Coverage (UHC), there is much emphasis on the need for an inclusive development approach. To achieve this, communities need to be at the centre of interventions and must have the knowledge and resources to drive their own development agenda according to their local needs. However, in rural Zambia, as in many other sub-Saharan African contexts, communities continue to face multiple barriers in accessing basic services. Underlying factors include geographical, financial and social constraints.

The MAMaZ Against Malaria (MAM) and MAM@Scale projects aimed to reduce preventable deaths from severe malaria by introducing and expanding the availability of an innovative pre-referral intervention at community level in remote rural districts in Zambia over the period 2017-2021. In this evidence brief, we share the final results of the MAM@Scale project.

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Technical Brief: USAID Community Capacity for Health Programme “A Bicycle Micro-Enterprise Approach to Improving Community Health Worker Mobility and Motivation in Rural Madagascar”

In much of rural Madagascar – where over 60 percent of the population lives – a lack of access to affordable and reliable transport hinders uptake of health services. Community Health Volunteers (CHVs) are essential in health service delivery and have key roles in implementing the country’s strategy to achieve universal health coverage. Despite this though, they do not receive a salary from the government and face the same transport barriers affecting rural communities.

Transaid has been an instrumental programme partner in the establishment of “enterprise box” or eBox initiative, as part of Mahefa Miaraka’s broader integrated approach to address transport-related barriers to accessing healthcare. The eBoxes are bicycle sale and repair micro-enterprises managed by registered cooperatives that aim to overcome some of the transportation barriers face by the local population.

The eBox incentivises the ongoing participation of cooperative members through income-generating activities (IGA) and provides strategic support to other integrated transport activities including providing bicycles to selected CHVs to improve their ability to travel, maintaining local bicycle-ambulances, and increasing transportation options for the local community. The profit generated by the cooperatives also provides support to local health insurance schemes (mutuelles de santé and caisse santé) that reimburse participating community members for medical costs incurred at local health centres.

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Technical Brief: USAID Community Capacity for Health Programme “Community-Led Transport Solutions Improve Access to Health Care”

In Madagascar, the mortality rates for mothers and children under five (CU5) were 335 and 51 per 100,000 in 2019, respectively. Delays in seeking access to quality care are a key contributor to maternal and under-five mortality. Inadequate access to transport has been identified as one of the three major reasons for delays in access to health services, and can worsen the clinical severity of cases, especially when complications exist.

In a context where the availability of transport is often low, the cost of emergency transport is frequently a major barrier. Moreover, difficult terrain and seasonal rainfall often limit access by motorized vehicles to many areas. In areas supported by the USAID Community Capacity for Health program, 44 percent of communities were inaccessible by car or truck for at least four months of the year and 20 percent were inaccessible for almost half the year.

Maximizing the potential for communities to develop and manage their own emergency transport schemes has been shown to be an effective method of increasing access to health care by drawing on available community resources.

Transaid has been instrumental as a key programme partner in the establishment of the community based transport solutions, bringing over a decade of practical experience in operating similar models across sub-Saharan Africa. As always, large focus was given to the sustainability and embedment of such models within the communities they serve.

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Manual: eBox Management Guidelines (Malagasy)

The USAID Community Capacity for Health program is an integrated community health program funded by USAID for five years (June 2016- June 2021). The program, Mahefa Miaraka, is implemented by JSI Research & Training Institute, Inc., in partnership with FHI 360, Transaid, and Action Socio-Organization Secours (ASOS), and in close collaboration with the Ministry of Public Health.

The eBox initiative follows a social enterprise approach and generates income as a bicycle workshop which sells and repairs second-hand bicycles. The eBoxes were introduced to respond to gaps in the bicycle sales and repairs market, and focus on building local skills amongst community members to ensure a long lasting impact.

This ‘Complete Simplified Manual’ has been developed to provide guidance to all those associated with managing and operating the eBox. It provides information on the roles and responsibilities of those associated with the eBox including the Board of Directors and eBox staff. An abridged version of this manual is also available, which focuses on essential tasks for eBox staff members.

Click below to download the full manuals in Malagasy.