Motorcycle (Boda Boda) referral system saves mothers and babies in hard-to-reach areas in West Nile
Transporting mothers and babies to access healthcare
In Uganda, especially in rural areas, communities are located very far away from health facilities, causing delays in accessing healthcare for many, especially for women and children. This is no different in Alangi sub-county in Zombo, a hard-to-reach district in West Nile, northern Uganda. To get to the sub-county located 20kms from Zombo District, one has to maneuver a bumpy and dusty road and a wooden bridge.
To address the challenge of not being able to access healthcare in time, UNICEF – through AVSI and with funding from the Swedish International Development Cooperation Agency (SIDA) – has introduced a boda boda (motorcycle) referral transport system to reduce the barriers related to distance, lack of transport means and cost of travel. This supports timely seeking of healthcare for pregnant mothers in labour, those with danger signs like bleeding, as well as newborns and children with complications. The system, which was introduced in 2018, supports referrals from communities to health centres and from health centres to hospitals.
At about 11 a.m. at Alangi Health Centre III, a boda boda pulls into the health facility compound with a pregnant woman, accompanied by a relative. She is in labour. Her home is nine kilometres away from the facility but through a telephone call, the expectant mother was immediately picked up and whisked to the health centre. The baby is due any time.
How does the system work?
The boda boda referral transport system involves Village Health Team (VHT) members who have registered pregnant women in their catchment area and are trained to identify women in labor, those with danger signs such as bleeding, malaria and diarrhea, and sick children. These receive first aid where possible and are referred to health facilities for medical attention with a referral form and transported by a boda boda.
In Alangi, the community has identified 10 boda boda riders whose telephone contacts have been shared with community members. UNICEF support has helped to train these riders who were equipped with skills in basic first aid, road safety and how to manage mothers in case they progress into second stage of labour while on the way to the health facility. The motorcyclists are on call at all times to transport mothers and children and are awarded payment vouchers for the great work done.
Testimonies from mothers
Doreen Ngabiwaga, 26 years, and a mother of two, happily plays with her one-year old son. Her home is located eight kilometres from Alangi Health Centre III, the nearest health facility. The labour pains begun at about 7 p.m. after she had her supper. “I tried to sleep but couldn’t,” says Ngabiwaga.
She quickly went to a neighbor to borrow a phone which she used to call the VHT, who called a boda boda. The rider arrived quickly and immediately took her to the health centre. By morning she had safely delivered her baby with support of a trained health worker. The experience was so different from her first pregnancy when the referral system was not available. “It was very hard, I had to save some little money that I paid for transport to the facility,” says Doreen. “But with the second one, I spent nothing, the boda boda was free of charge.” She also recalls that during pregnancy, when she was unwell, the boda boda had taken her to the facility for treatment.
Fuanega Anna, 35 years, and a mother of five, rocks her baby to sleep after breastfeeding, outside her house. Baby Desire Mungucwiyu is only 2 months old. Fuanega is happy that she delivered her babies at the health facility but when she speaks of the last experience, she beams. “The labour pains started at 1 a.m. but fortunately I had taken down the number of the motorcyclist. I called him and he arrived very fast. “My home is 7 kilometres away from the health facility but the rider assured me that he would transport me safely to the health facility,” she says. “Indeed, it was true. He took me carefully; even at the steep valley we went slowly because I was in pain. To my surprise he had already called the health worker who received me.”
She requests that the system should continue. Before its inception, Fuanega had walked to the health facility to deliver her baby and had checked in a week or two before delivery to avoid any delays and complications.
The changes at the health facility
Tony Otim, Clinical Officer at Alangi Health Centre III says that the maternal and child health supported interventions at the facility have boosted the uptake of services in Zombo District. In Alangi sub-county, in particular, maternal mortality rates have been significantly reduced. Neonatal death rates have also decreased.
He confirms that the transport referral system has shortened the time taken by mothers to get from home to a health facility. Complications that were common due to such delays have been managed by the intervention. Today, the facility delivers 75 babies a month compared to 30 in 2018 as more and more mothers continue to deliver at the health facility. The numbers of antenatal care visits have also increased, and the number of pregnant mothers experiencing complications has gone down because they are identified early and provided with treatment and care.
Alangi Health Centre III also boasts of a refurbished maternity ward with space for mothers, an improved labour suite with a sterilization room, a bathroom, a Kangaroo Mother Care room, a resting room, delivery beds and resuscitation equipment, all of which have had a positive impact on the quality of services, thanks to SIDA funds.