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 Program – 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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MAM@Scale COVID-19 Response: Signs and Symptoms Poster

Since the COVID-19 outbreak, many have faced unprecedented challenges around the world. Like many organisations, Transaid has been adapting and finding new ways of working, and making sure that all staff, consultants and volunteers are protected and safe. Consequently, Transaid has been working to introduce new protocols and ways of working for our colleagues in the field.

As part of this, Transaid have been focusing on awareness raising, establishing hand washing stations and topping up the community food banks as part of the preparedness planning in the MAM@Scale intervention sites in Zambia. This also included the development of materials aimed at supporting awareness raising activities, and to ensure that the people on the frontline of project operations, as well as the people they are supporting, are safe and protected at all times.

Please click below to see the “Signs, Symptoms and Response” Posters in English, Bemba, Chewa, Senga, and Luvale.

Training Manual Use of Rectal Artesunate as a Pre-Referral Intervention for Severe Malaria at Community Level

Malaria incidence rates among children are very high in many rural districts of Zambia. Every year, many children die when their malaria progresses to severe malaria because they have not received appropriate or timely treatment. Many of these deaths could be avoided if communities were effectively mobilised around a child health agenda and if WHO-approved rectal artesunate (RAS) – a life-saving pre-referral treatment – were readily available at community level.

Children also suffer and sometimes lose their lives because of delayed identification of other common childhood illnesses. These include severe diarrhoea and acute respiratory infection (ARI). Gaps in knowledge of the danger signs for all these illnesses, and household and community barriers and delays that prevent prompt referral of children are responsible.

This training manual outlines a two-part training approach that can be used to:

Train selected Community Health Volunteers (CHVs) to recognise and administer severe malaria in young children using rectal artesunate (RAS)

Train communities to respond promptly and appropriately to severe malaria, and to other common childhood illnesses

Increasing children’s access to life-saving treatment for severe malaria and other common childhood illnesses requires community members who can identify danger signs and know how to respond, and CHVs who can support and refer patients to the health facility. Both groups need to be trained.

Please click below to read the full training manual.

Emergency Transport Scheme (ETS) Training Guide for Trainers of Bicycle Ambulance (April 2019)

Emergency Transport Schemes (ETS) offer an affordable means of transportation for health emergencies and patient referrals to health facilities, in communities where no formal transport services exist, or where affordable means of transportation lack.

This training manual is intended for trainers who are conducting training on ETS, and introducing bicycles as a solution for community based transport to help expecting mothers and under 5 children with severe malaria in accessing health care when in labour and six weeks after child birth. The topics in this manual have been logically arranged to help guide the trainer follow an approach which aims to maximise the impact of the ETS introduction through clear messaging and instruction.

 The purpose of the ETS training is to develop the knowledge and skills of the community volunteer ETS riders so that they can professionally, safely, actively and effectively contribute to reducing the delay on maternal emergencies and children with severe malaria faced in accessing transportation. This manual acts as a learning tool and reference to be used in conducting training geared towards achieving this. It contains the course layout, proposed timings and gives the trainer comprehensive guidance on critical issues relating to the successful operation of a community managed ETS. It is not meant as a document for general distribution among all ETS volunteer riders, rather for trainers.

Please click below to read the full guide.

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.

Policy Brief: Opportunities to maximise the benefits of motorcycle and three-wheeler taxis in rural Africa

This policy brief is intended to enhance the knowledge and understanding of policy makers and other key stakeholders on the benefits of safe use of motorcycle and three-wheeler taxis in rural contexts in sub-Saharan Africa.  A cross-country study was carried out in 2018 in Ghana, Kenya, Tanzania and Uganda investigating the use of motorcycle and three-wheeler taxis in rural areas. This brief presents the key findings of the research as well as key recommendations for decision-makers.

To read this brief, please 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.