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.

Click below to read the full technical brief.

Case study: Chitambo District Health Office (DHO) partnering with MAM@Scale in the COVID-19 response

The collaboration between Chitambo District Health Office (DHO) and MAM@Scale has been very effective, not only in the treatment of severe malaria at community level using rectal artesunate, a pre-referral drug, but also developing strong preventative measures against COVID-19 in this transit town.

MAM@Scale uses a strong community engagement approach by establishing and strengthening community systems to uplift health standards at community level. It is an inclusive approach that engages people at all levels, from traditional leadership to members of the community. People who volunteer to work for the community are trained in health education and become the providers of basic health services at community level. Food banks and savings schemes are formed in the communities to fight affordability barriers. This has not only raised demand for health services in the facilities that MAM@Scale is supporting in Chitambo district, but it made it much easier to put up preventative measures against COVID-19.

Click below to read the full case study.

Case Study: Baron educates people on malaria, emergency transport systems and COVID-19 on air

Fwanta is a community in the Kabamba area of Serenje District, Zambia.  In the past, many people in Fwanta who developed medical complications, be it maternal or malarial related, died because people wrongly interpreted the danger signs.

A turning point happened when MAMaZ Against Malaria at Scale (MAM@Scale) began working with this community and the Kabamba Rural Health Centre. They trained Community Health Volunteers (CHVs) on the management of severe malaria at community level through the administering of a Rectal Artesunate Suppository (RAS). MAM@Scale also provided an emergency transport system (ETS), in the form of a bicycle ambulance, to Fwanta.  Baron Mupeta was one of the people selected to be trained as an ETS rider.

Click below to read Baron’s testimonial.

Case Study: Brenda Kundo

Community Health Volunteers (CHVs) are the backbone of the health system in rural Zambia, where they provide invaluable health advice to their communities, which are located prohibitively far from health facilities. Before the pandemic, CHVs were a vital part of our MAM at Scale programme, combatting malaria in their community by educating families on the danger signs of severe malaria and administering RAS (rectal artesunate suppositories), a pre-treatment for children with suspected severe malaria.

CHVs are a trusted voice in their communities, so it was natural that they would form the cornerstone of MAM at Scale’s COVID-19 response. To meet the challenges of the pandemic, the MAM at Scale team has orientated nine Community Facilitators on COVID-19, who have in turn trained 1,379 CHVs, who will help keep their communities safe during the pandemic.

Brenda Kunda is a Community Facilitator with MAM at Scale. A tragic experience in Brenda’s life eventually led to a positive change, not only for her, but for her family and her entire community.

Click below to read Brenda’s story.

The potential role of mobile phone technology in rural motorcycle and three-wheeler taxi services in Africa

Over the last two decades, motorcycle and motorised three-wheeler taxis have become important means of transport in many sub-Saharan African countries, including in rural areas. However, the emerging role of mobile phone technology in improving mobility in rural areas is currently under-explored in the literature.

This paper presents the findings of a small-scale research study that was undertaken into the use of mobile phone technology in the context of motorcycle and three-wheeler taxi use, and its potential to improve rural access. Informed by a literature review, the research focuses on four countries: Kenya, Rwanda, Tanzania and Uganda. Semi-structured interviews and focus group discussions were conducted with riders of motorcycle and motorised three wheeler taxis and the developers of mobile phone-enabled transport technologies.

Mobile technology linked to the utilisation of motorcycle and three-wheeler taxis is increasing, but ‘ride hailing’ applications (apps) are likely to be limited to urban areas for the foreseeable future due to various disincentives to their use in rural areas. The study identifies several promising innovations that combine the use of motorcycles and three-wheelers with mobile technology to increase rural people’s access to essential services and opportunities. These have the potential to be scaled up or expanded to other countries.

To read the full the article, click below.

Guide Des Formateurs Des Transporteurs

Le programme MAHEFA Miaraka (juin 2016- juin 2021) vise à renforcer les capacités du secteur public à planifier, fournir et gérer les services de santé communautaire, tout en redynamisant l’engagement communautaire et l’appropriation de la santé. 

Dans le cadre de la mise en œuvre du Plan de Développement du Secteur de la Santé à Madagascar (PDSS 2015-19), le programme Mahefa Miaraka soutient les moyens de transport d’urgence existants dans ses zones d’intervention, afin d’améliorer l’accessibilité de la communauté aux soins de santé en cas d’urgence sanitaire ou orientation des patients. L’objectif est de donner aux communautés les moyens d’améliorer et d’utiliser efficacement leurs propres plans d’évacuation médicale vers les centres de santé de base (CSB), les hôpitaux de district et les hôpitaux régionaux de référence. 

Ce guide servira d’outil aux formateurs. Il découle de la politique nationale de santé communautaire et a été conçu à partir de l’expérience antérieure du programme et de ses partenaires. 

Pour consulter le manuel en francais ou en malgache, cliquez sur le lien ci-dessous. 

Manuel Des Conducteurs Des Transports Publics

Le programme MAHEFA Miaraka (juin 2016- juin 2021) vise à renforcer les capacités du secteur public à planifier, fournir et gérer les services de santé communautaire, tout en redynamisant l’engagement communautaire et l’appropriation de la santé. 

Dans le cadre de la mise en œuvre du Plan de Développement du Secteur de la Santé à Madagascar (PDSS 2015-19), le programme Mahefa Miaraka soutient les moyens de transport d’urgence existants dans ses zones d’intervention, afin d’améliorer l’accessibilité de la communauté aux soins de santé en cas d’urgence sanitaire ou orientation des patients. L’objectif est de donner aux communautés les moyens d’améliorer et d’utiliser efficacement leurs propres plans d’évacuation médicale vers les centres de santé de base (CSB), les hôpitaux de district et les hôpitaux régionaux de référence. 

Ce guide servira d’outil aux chauffeurs et chauffeurs assistants sur les précautions à prendre lors d’une évacuation sanitaire communautaire de patients vers le CSB, les hôpitaux de district et les hôpitaux régionaux de référence. Il découle de la politique nationale de santé communautaire et a été conçu à partir de l’expérience antérieure du programme et de ses partenaires. 

Le Guide clarifie les engagements des chauffeurs et leurs rôles pendant et après le transport d’urgence des patients. Ce guide fournit également des détails sur les mesures à prendre pour leur propre protection et pour la protection du patient transporté ainsi que des autres passagers. La formation aux premiers secours doit rassurer et renforcer la confiance des conducteurs dans la réalisation du transport d’urgence des patients. 

Pour consulter le manuel en francais ou en malgache, cliquez sur le lien ci-dessous. 

Insights on motorcycles and motorised three wheelers: before and during COVID-19 – Transaid webinar slides

On 30th June Transaid hosted a webinar exploring motorcycle and three-wheeler use in five sub-Saharan African countries. Speakers and panellists held a discussion on the research funded by the Department for International Development (DFID) as part of the Research for Community Access Partnership (ReCAP), and shared insights on what’s changed with COVID-19.

Speakers: Ms. Caroline Barber – CEO, Transaid. Ms. Kim van der Weijde – Project Manager, Transaid

Panellists: Dr. Nono Mvuama – University of Kinshasa. Mr. Kevin Mubadi – Chairman, Boda Boda Safety Association of Kenya. Ms. Grace Wahome – Programme Director, International Forum for Rural Transport and Development (IFRTD)

Watch the webinar here.

Click below to download the webinar deck.

Améliorer la compréhension sur l’utilisation sécurisée des motos et motos à trois roues pour le transport rural – Rapport Final: République Démocratique du Congo

Ce rapport final de la RDC présente les conclusions spécifiques à la RDC du projet «Améliorer la compréhension sur l’utilisation sécurisée des motos et motos à trois roues pour le transport rural». Ce projet a été réalisé en RDC entre février 2019 et décembre 2019.

Research for Community Access Partnership (ReCAP) est un programme de recherche, financé par UK Aid, dans le but de promouvoir des transports sûrs et durables pour les communautés rurales d’Afrique et d’Asie. ReCAP comprend le Africa Community Access Partnership (AfCAP) et le Asia Community Access Partnership (AsCAP). Ces partenariats soutiennent le partage des connaissances entre les pays participants afi d’améliorer l’adoption de solutions éprouvées à faible coût pour l’accès rural qui maximisent l’utilisation des ressources locales. Le programme ReCAP est géré par Cardno Emerging Markets (UK) Ltd.

La stratégie et la méthodologie de recherche sont largement basées sur celles utilisées pendant la phase initiale de recherche dans quatre pays du projet, appliquée au Ghana, au Kenya, en Tanzanie et en Ouganda en 2018. Après un premier voyage de cadrage (scoping) en RDC qui a eu lieu en février 2019, la stratégie a été examinée et finalisée en même temps que l’identification des principales parties prenantes et partenaires. Les activités comprenaient un examen du cadre réglementaire et de la formation existante, une enquête sur les avantages et les inconvénients des motos et des taxis à trois roues et des entretiens avec des informateurs clés.

Les résultats de cette étude peuvent être utilisés par le gouvernement de la RDC et d’autres parties prenantes clés pour mieux comprendre les problèmes liés à l’utilisation des motos-taxis dans les zones rurales et pour développer des politiques et des pratiques pour afin de maximiser les avantages et minimiser les inconvénients. Un certain nombre de recommandations sont présentées dans ce rapport. Une activité complémentaire est explorée avec les acteurs locaux sur la base des résultats de cette étude, afin d’influencer positivement les conditions pour les opérateurs et utilisateurs de motos et de trois-roues motorisés.

Pour lire le rapport complet, veuillez cliquer ci-dessous.

Opportunités pour maximiser les avantages des taxismotos et motos à 3 roues dans les zones rurales de la République Démocratique du Congo

Cette fiche technique a été élaborée sur la base d’une étude de 2019 sur les motos et motos à 3 roues dans les zones rurales de la RDC. Le but de l’étude était d’améliorer les connaissances et la compréhension actuelles concernant les moyens efficaces de permettre aux populations rurales de bénéficier d’une utilisation sûre des motos et des trois-roues motorisés. Les résultats de l’étude peuvent être utilisés pour améliorer le fonctionnement de ces véhicules afin de fournir un accès sûr, abordable et socialement inclusif aux communautés rurales.

Le projet a été soutenu par le gouvernement de la RDC par le biais de l’institution locale partenaire de l’AfCAP, Cellule Infrastructure, un organisme technique du ministère de l’Infrastructure, des Travaux publics et de la Reconstruction, et financé par UK Aid.

L’utilisation des motos a considérablement augmenté en Afrique subsaharienne ces dernières années. Les motos sont souvent utilisées comme taxis, les conducteurs facturant un tarif pour transporter des passagers ou des marchandises. Les trois-roues motorisés sont également utilisés dans certaines zones rurales, bien que leur nombre soit beaucoup moins élevé.

Les taxis-motos jouent un rôle essentiel pour permettre la mobilité rurale en Afrique. Dans de nombreux pays, ils sont le seul moyen de transport motorisé abordable disponible pour les personnes vivant dans les communautés rurales et sont devenus un mode de transport de plus en plus populaire.

Ils donnent accès aux soins de santé, y compris en cas d’urgence médicale, ainsi qu’aux les marchés et les installations communautaires. Ils fournissent également des emplois et génèrent un revenu raisonnable, principalement pour les jeunes hommes.

Le projet fait partie du partenariat de recherche pour l’accès communautaire (ReCAP) financé par UK Aid, dans le but de promouvoir des transports sûrs et durables pour les communautés rurales d’Afrique et d’Asie. ReCAP comprend le Partenariat d’accès communautaire en Afrique (AfCAP) et le Partenariat d’accès communautaire en Asie (AsCAP). Ces partenariats soutiennent le partage des connaissances entre les pays participants afin d’améliorer l’adoption de solutions à l’efficacité prouvée à faible coût pour l’accès rural qui maximise l’utilisation des ressources locales. Le programme ReCAP est géré par Cardno Emerging Markets (UK) Ltd.

Pour lire l’intégralité de la fiche technique, veuillez cliquer ci-dessous.

Enhancing understanding on safe motorcycle and three-wheeler use for rural transport Final Report: Democratic Republic of Congo

This DRC Final Report presents the DRC-specific findings of the project ‘Enhancing understanding on safe motorcycle and three-wheeler use for rural transport and the implications for appropriate training and regulatory frameworks’. This project was carried out in DRC between February 2019 and December 2019.

Research for Community Access Partnership (ReCAP) is a research programme, funded by UK Aid, with the aim of promoting safe and sustainable transport for rural communities in Africa and Asia. ReCAP comprises the Africa Community Access Partnership (AfCAP) and the Asia Community Access Partnership (AsCAP). These partnerships support knowledge sharing between participating countries in order to enhance the uptake of low cost, proven solutions for rural access that maximise the use of local resources. The ReCAP programme is managed by Cardno Emerging Markets (UK) Ltd.

The research strategy and methodology is broadly based on those used during the initial four country research phase of the project, applied in Ghana, Kenya, Tanzania and Uganda in 2018. After an initial scoping trip to DRC that took place in February 2019, the strategy was reviewed and finalised together with identifying key stakeholders and partners. Activities included a review of the regulatory framework and existing training, a survey of the benefits and disbenefits of motorcycle and three-wheeler taxis, and key informant interviews.

The results of this study can be used by the DRC government and other key stakeholders to better understand the issues related to the use of motorcycle taxis in rural areas and to develop policy and practice to maximise the benefits and minimise the disbenefits. A number of recommendations are presented in this report. A supplementary activity is being explored together with local stakeholders based on the findings of this study, in order to positively influence the conditions for operators and users of motorcycles and motorised three-wheelers.

To read the full report, please click below.

Opportunities to maximise the benefits of motorcycle and motorised three-wheeler taxis in rural Democratic Republic of Congo: Policy Brief

This policy brief has been developed based on a 2019 study of motorcycles and motorised three-wheeler taxis in rural areas of DRC. The aim of the study was to improve the current knowledge and understanding concerning the effective ways of enabling rural people to benefit from the safe use of motorcycles and motorised three-wheelers. The results of the study can be used to enhance the operation of these vehicles to provide safe, affordable and socially inclusive access for rural communities.
The project was supported by the Government of DRC through the local AfCAP partner institution Cellule Infrastructure, a technical body of the Ministry of Infrastructure, Public Works and Reconstruction, and funded by UK Aid.

The use of motorcycles has increased greatly in sub-Saharan Africa in recent years. Motorcycles are often used as taxis, with riders charging a fare to carry passengers or goods. Motorised three-wheelers are also used in some rural areas, although their numbers are far fewer.
Motorcycle taxis play a critical role in enabling rural mobility in Africa. In many countries, they are the only available means of affordable motorised transport for people living in rural communities and have become an increasingly popular mode of transport.
They provide access to healthcare, including in medical emergencies, as well as access to markets and social amenities. They also provide employment and generate a reasonable income, predominantly for young men.

This project is a part of the Research for Community Access Partnership (ReCAP) funded by UK Aid, with the aim of promoting safe and sustainable transport for rural communities in Africa and Asia. ReCAP comprises the Africa Community Access Partnership (AfCAP) and the Asia Community Access Partnership (AsCAP). These partnerships support knowledge sharing between participating countries in order to enhance the uptake of low cost, proven solutions for rural access that maximise the use of local resources. The ReCAP programme is managed by Cardno Emerging Markets (UK) Ltd.

To read the full policy brief, please click below.