The high rate of maternal mortality in Africa is a worldwide concern. The global targets of Millennium Development Goal (MDG) no 5 are to reduce maternal mortality by three-quarters and achieve universal access to reproductive health by 2015.
Yet progress is almost at standstill in much of sub-Saharan Africa and is seen as a global failure to address the disastrous consequences for many African mothers and their families. Of 342,900 maternal deaths in 2008, half were in sub-Saharan Africa. Transaid’s practical experience is that vital to improving the targets is appropriate, available and well-managed transport. And research confirms this.
A comprehensive study of district health services in 41 countries showed lack of transport to be one of three most common barriers to women seeking obstetric care. Another demonstrated how transport services are crucial in providing access to both preventive and emergency care in childbirth. It states that transport plays, “a key role in the survival of women and their newborn children, as complications in birth may rapidly become life-threatening.”  The authors estimate that over 75% of maternal deaths could be prevented through timely access to essential care in childbirth.
Transaid’s approach is to develop and implement simple transport management systems (TMS) to support the efficient operation of not-for-profit fleets, mainly in government health ministries. TMS includes developing transport policies, training transport officers and drivers, data collection and analysis of items such as fuel consumption, vehicle usage and maintenance costs, and establishing preventive maintenance regimes.
We also work with communities directly to help them to use and manage their own transport so that they can deliver emergency health services. One observer says, “commitment, money and innovation”, channelled effectively through local communities and service providers, make the difference between significantly reducing maternal mortality and failing to do so. That is very important where there is no public or government-owned transport. It is different to working within government health transport systems, but the two approaches are complementary.
Transaid successfully applies these wider lessons about community-managed transport to help reduce maternal mortality in Africa. Examples include enabling the effective management of government ambulances, the introduction of public-private emergency transport services, and rural solutions such as motorcycle or bicycle ambulances.
Currently, Transaid works with the Ministry of Health (MoH) in rural northern Nigeria within a programme to improve maternal and child health, and in a country where maternal mortality is near the world’s highest. Transaid’s initial transport assessment revealed less than 200 working MoH vehicles to serve over 16 million people. We developed a series of projects to improve health access and health care delivery.
With the MoH we trained ambulance-driver trainers to ensure efficient running of existing and any new vehicles. Because of the lack of infrastructure, we also worked closely with a local transport union to reach into rural communities. This project encourages taxi drivers – all men – who voluntarily use their vehicles to carry pregnant women to a health facility to give birth more safely. It minimises delays for women seeking urgent health care.
The scheme sensitises and trains drivers in safe transport, lifting and handling pregnant women, about the most important danger signs in pregnancy and delivery, and how to record key data for each case. A big plus is that it motivates the wider community to support women’s health. It currently transfers almost 1,000 women per month.
Appropriate transport is a vital component of effective health systems for emergency maternal health care. The referral of pregnant women during labour, the presence of qualified staff, drugs and medical equipment, and the movement of lab tests and samples require effective transport. Better transport operation significantly supports reductions in maternal mortality. Indeed, for wider public health services, it makes health care more effective and accessible, and reduces transport costs so that the money can be used directly for health care.
A focus on transport encourages effective commitment and innovation, in local communities and more widely, at the same time as it saves money. For this to happen, and to increase the chances of meeting the maternal health MDG and other development goals, there must be a stronger recognition of the role that transport plays in health services development in Africa.
Beyond this number one issue of improving MDG targets through better transport, Transaid sees a bigger truth. Improved transport means better health services and better clinical and management outcomes – not only in developing countries but, for example, here in the UK too.
 Hogan MC, Foreman KJ, Naghavi M, et al. (2010) Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet; Published online April 12. DOI:10. 1016/SO140-6736(10)60518-1.
 Lee, Anne et al. (2009), “Linking families and facilities for care at birth: what works to avert intrapartum-related deaths?”, International Journal of Gynaecology and Obstetrics 107: S65
 Babinard, Julie and Roberts, Peter (2006), “Maternal and child mortality development goals: what can the transport sector do?” World Bank Transport Papers 12:1
 Urdang, Stephanie (2010), ‘New drive to save the lives of mothers, infants’, Africa Renewal, 23:4
 World Health Organisation Statistics Report 2009
Transaid is a British NGO providing effective, innovative, appropriate and sustainable transport management solutions to increase access to health and otherbasic services, improve their efficiency, improve livelihoods and help reduce poverty, mainly in Africa.
Chris Cuninghame and Gary Forster, Transaid