Community referral system save lives during the COVID-19 pandemic lock down

Key highlights of SIDA support to West Nile through UNICEF

maternal health, newborn health, safe hands, clean hands, hospital deliveries, ambulances, motorcycle ambulance
AVSI Uganda/2020
21 May 2020

The community transport system

The community transport (commonly known as boda-boda) voucher referral system is an initiative to address the second delay to health care access by mothers and newborns. Through this system, a pregnant woman, mother of a newborn or child under the age of 5 – identified in the community by Village Health Teams – is transported on a boda-boda to reach the nearest health facility for medical attention. According to the Maternal and Perinatal Death Surveillance and Review (MPDSR) report of 2018/19, the West Nile Region accounted for nearly 10 per cent of the maternal deaths reported in Uganda in 2019.

The voucher system is facilitated by AVSI Foundation and UNICEF with funding from SIDA under the District Health System Strengthening Project in the 11 districts of West Nile. The project provides integrated reproductive, maternal, newborn child and adolescent nutrition and HIV services to host and refugee communities. The voucher system also serves both refugee and host communities. Through special clearance from the Ministry of Health and district authorities in West Nile, 694 designated boda-boda have continued to provide an essential service to women and children amidst the COVID-19 situation in the country.

How the community referral system is adapting to the context of COVID-19

In the context of COVID-19, the boda-boda riders were oriented on the Ministry of Health guidelines on COVID-19 prevention and control of infections. They were also provided with alcohol-based hand sanitizers and personal protective equipment, including face masks. As per recent guidance from the ministry, the boda-boda drivers and pregnant women will be supplied with cloth masks to ensure continuation of the services.

In the two months (March–April 2020) of the lock down, SIDA support enabled the referral for medical attention of 1,464 pregnant women with danger signs by the boda-boda system.

Lessons learnt

Communities and District Health Teams recognize that great importance of the community transport voucher referral system in saving lives. It is a vital component of the district ambulance and referral network.

The voucher-based community referral system is cost effective and an accessible mode of service for the rural poor, especially those living in remote and rugged areas.

Voices from the communities

maternal health, newborn health, safe hands, clean hands, hospital deliveries, ambulances, motorcycle ambulance
AVSI Uganda/2020

“My labour began in the night and I was alone at home. I live in Mijikita village, 18km from Kerwa Health Center III. I called Abib Ezale (a boda-boda rider) and he came to pick me. We arrived at Kerwa at 8:00 am and I gave birth to a baby girl. I thank Abib for helping me," pregnant mother in March 2020.

maternal health, newborn health, safe hands, clean hands, hospital deliveries, ambulances, motorcycle ambulance
AVSI Uganda/2020

“We now get up to have 30 births in a month. We barely reached 15 previously. Our pregnant mothers living in rough terrains and across the seasonal rivers can now reach a health facility using a boda-boda, without a mother having to spend money," Midwife at Eliofe Health Center III, Maracha District.

maternal health, newborn health, safe hands, clean hands, hospital deliveries, ambulances, motorcycle ambulance
AVSI Uganda/2020

Saved by a boda-boda: Consolate felt feverish on the night of 5 May 2020. Her husband knocked at the door of their Village Health Team member for assistance – the Village Health Team is part of the boda-boda referral system; he drove Consolate to Pakadha health facility where she arrived unconscious and was diagnosed and treated for severe malaria in pregnancy. Consolate Ayiorwoth, 21, lives in Sang village in Zombo District, 16 km from the nearest health facility. “I thought my son was gone,” Irene Afoyorwoth, mum to Brian. Two-year-old Brian is still receiving treatment at Padea health centre after he was driven there on 8 May 2020 by the boda-boda. Brian is receiving treatment for malaria and is recovering.

Continuation of the ambulance referrals

SIDA support has been instrumental to continue the inter-facility referrals in the West Nile region. Despite restriction on movement from late March 2020, UNICEF – through financial support from SIDA – continued to work with the District Health Teams to update the availability of functional ambulances and provide fuel for ambulance referrals at district level. Fuel was also provided to hospitals, including Arua Regional Referral Hospital and Angal, Nyape, Kuluva and Maracha hospitals, to facilitate the inter-facility referrals of complicated maternal and newborn cases. During the lock down period, 1,534 complicated cases were referred to the higher-level health facilities using the ambulances. This constitutes 61 per cent of the total referrals since January 2020. UNICEF, with support of AVSI and District Health Teams, will continue to monitor the referrals and document good practice to promote cross-district learning. UNICEF takes this opportunity to thank SIDA for the continued and uninterrupted support to the women and children in Uganda.