Democratic Republic of Congo, Kwilu Province, Mosango health district
Saving lives with moto-ambulances
Some rather unusual vehicles have been spotted in certain rural areas of the DRC.... They are motorbikes fitted with padded chairs for passengers, called 'moto-ambulances' (motorbike ambulances). They are contraptions, which, in all modesty, have earned a reputation for having saved the lives of many pregnant women, but also children and adults in critical conditions.
According to the most recent demographic and health survey in the DRC, 1 woman of childbearing age in every 18 dies during pregnancy (1). It is an appalling statistic.
These women die following complications during pregnancy or childbirth. However, with the right approach, most of these mothers could be saved if complications were detected in time by professional medical supervisors.
These women include the so-called "at risk" groups: young girls who are pregnant for the first time, but also mothers who think they are invulnerable because they have already given birth to 6 or even 8 children.
But why don't these soon-to-be mothers, and all these other at-risk groups, just go to the health centre?
That's where the dual problem of financial and geographical accessibility comes into play.
You need to imagine being in an isolated village, only connected by roads in poor condition, not served by public transport and without a GSM network.
If you need to call and wait for a hypothetical ambulance to arrive, it sometimes has to serve an area as large as Belgium. In other words, the patient will already be dead....
This is why Memisa, an NGO partner of the Belgian Development Cooperation, has developed alternative means of transport, in collaboration with the management teams of the health districts, which is a cross between the traditional tchipoy and the highly sought-after but unavailable 4x4 ambulance. Given the poor condition of the roads, which are made worse by frequent rains, our partner found that in some places where roads are impassable, motorbike ambulance transport is a viable and highly effective alternative.
It's better to face the realities on the ground than long for a dream solution. So motorbikes have been adapted to transport patients between health centres and hospitals. After a lot of brainstorming and tests in the field, Memisa successfully developed a kind of motorbike ambulance consisting of a standard motorbike which has a locally made padded seat on the back, on which the patient can be transported. Passengers wear a seat belt during transport to remain stable.
Other types of motorbike ambulances which were tested in the field, where for example the patient was lying down, gave less satisfactory results in terms of stability during the patient's transport.
But it doesn't work !
As such, a representative management committee manages the community moto-ambulance at the Health Centres.
To finance the "ambulance solidarity fund", every patient pays an additional fee, set at 500 Congolese francs (approximately 0.25 EUR), during their consultation at the Health Centre. As for the fee to be paid by the patient at the time of transfer with the moto-ambulance, this is set at 1000 Congolese francs (0.50 EUR).
As a result, the transport system for emergencies is self-financing, to pay for the driver, fuel, maintenance and minor repairs, which offers more reassurance as regards the sustainability of the system. Social control prevents the community moto-ambulance from being used for other purposes.
The initiative is therefore making a humble contribution to making care more accessible, both geographically and financially.
"I have already lost one child trying to get to hospital," says Gode (28). Exhausted having walked 30 km, my child was already dead when I arrived at the hospital. The nurse warned me that the delivery would be difficult. This time around, I refused to walk; I called for the moto-ambulance", she explains, with her baby in her arms.
It is with great satisfaction that the public has welcomed this system since, when needed, people can now access emergency transport at an affordable price. Of course, it is also important to ensure that nurses in the Health Centres provide quality care and know when it is necessary to transfer patients to hospital.
In the Mosango health district, in Kwilu (formerly Bandundu) for example, some 400 emergency transfers are made every year using these alternative means of transport, saving just as many lives and families.
The experiment conducted by Memisa since 2014 in Bandundu has since spilled over into other Congolese health districts*. The approach has also been integrated into the PADP** programme implemented by Enabel, the Belgian Development Agency. This integration has also made it possible to improve on the moto-ambulance prototype thanks to the partnership that Enabel has developed with local blacksmiths in the city of Gemena, in Sud-Ubangi province, through its programme in the technical education and vocational training sector (EDUMOSU).
This synergy between two Enabel programmes provides work for the local population, but also skills, and ensures the sustainability of the system, as repairs are carried out on-site.
*In the Bwamanda Health District (area of 2,500 km2 with 256,000 inhabitants), where PADP provided 6 moto-ambulances, 1,250 patients received emergency transport from these vehicles between 1 January 2018 and 31 October 2018, with a significant contribution to reducing maternal and infant mortality. In effect, 75% of transported patients are either children (50% of cases) or women with childbirth-related problems (25% of cases).
As such, other health districts where neither Memisa nor Enabel are active, and other donors and development agencies, are increasingly intrigued by this creative initiative which perfectly matches the current local conditions.
**Programme d’Appui aux Divisions Provinciales de la Santé et aux Zones de Santé (Support Programme for Provincial Health Divisions and Health Districts) of the Belgo-Congolese Cooperation
- (1) 2014-2015 demographic and health survey for the DRC p.211 (French)
- Pictures Memisa Belgium and PADP/Enabel
- Videos Memisa Belgium : Reportage 1 / Reportage 2 / Reportage 3
- Read also : "Rejoindre rapidement l'hôpital grâce à des moto-ambulances" (French)
- Memisa Belgium
- Enabel - Programme PADP