Project Summary
In September 2008 Transaid partnered with World Bicycle Relief and Disacare* to implement a pilot Bicycle Ambulance project in Zambia’s Eastern Province. This involved the construction and distribution of bicycle ambulance trailers to 40 volunteer healthcare workers, otherwise known as ‘home based caregivers’ (HBCs). The project aimed to improve rural access in communities where the cost of running and maintaining a 4 x 4 vehicle would be virtually impossible to meet with the existing resources available.
Click here to download the evaluation report which highlights the early outcomes of this project following bicycle ambulance distribution.
The Problem
More than 60% of people in developing countries live more than 8km away from the nearest health facility and this distance is likely to be increased in rural parts of Africa. To add to this problem, the relatively small number of health facilities available, coupled with the lack of appropriate emergency transportation, increases the difficulty of accessing healthcare for people in those communities.
In rural areas facing an HIV/AIDS crisis and high rates of child and maternal mortality, access to healthcare is hindered by unavailability of free ambulance services and the high cost of alternative forms of transportation. The existing means of emergency transport used in Eastern Province, such as going by foot, ox and cart or draping the patient over a bicycle seat are often slow, uncomfortable and unreliable.
Intermediate modes of transport such as the bicycle ambulance are an important part of the solution to this problem as Transaid’s previous experiences in the Malawi Bicycle Ambulance Project and the Nigeria Motorcycle Ambulance Project have revealed.
The Process
During the initial stage of the project, 40 bicycle ambulance trailers were built. Three models were designed with input from technical experts including Design for Development, Bicycle Empowerment Network Namibia and Disacare Zambia. This allowed Transaid to compare and evaluate their effectiveness, including durability and appropriateness for the terrain and the task in hand.
Ten field mechanics initially trained by World Bicycle Relief also received vocational training in the production and maintenance of the bicycle ambulances. This helped build capacity within Eastern Province to produce and maintain bicycle ambulances for future projects.
The bicycle ambulance trailers were then distributed to 40 community health caregivers across the three districts of Chipata, Katete and Petauke and a clear ownership structure was established at the community level. This was possible due to the structure already established by World Bicycle Relief who had delivered over 18,000 bicycles to caregivers over a period of 16 months as part of the RAPIDS project in Zambia.
A management system was put in place to record and analyse the information necessary to ensure the effective use of the bicycle ambulances. Each was distributed with a log book and maintenance sheet and caregivers were trained on how to record the information.
During the first three months of project implementation, data was collected relating to the utilisation of the bicycle ambulances and a monitoring and evaluation report was produced. Click here to download the report.
Partners
The RAPIDS consortium of non-governmental organisations including World Bicycle Relief and Disacare. Funded by Canadian International Development Agency (CIDA).
The Results
Forty bicycle ambulances were successfully built and distributed and 10 mechanics were trained in the construction and maintenance skills needed to ensure project sustainability.
The results of the project revealed that:
• The main reasons for emergency trips were HIV/AIDS related anti-retroviral therapy, malaria and pregnancy cases.
• 96% of home based caregivers interviewed stated that the bicycle ambulances enabled them to do their jobs more effectively.
• 86% of trips using the bicycle ambulance were viewed to be life-saving.
• A journey of 2.5km which would take between two and three hours by traditional ox and cart was reduced to just 30 minutes with a bicycle ambulance.
• The average distance travelled was 10.2km and the longest distance travelled was 28km.
The Impact
With comparatively low running costs, the bicycle ambulance has enabled people in rural communities to gain access to healthcare in times of emergency and has also saved lives. The placing of the bicycle ambulances within the community and the training of mechanics to carry out routine maintenance has also empowered the communities to be able to take more control of their own lives.
While this was run as a pilot program, it is hoped that the lessons learned through the monitoring and evaluation conducted by Transaid could become a model for thousands of bicycle ambulance trailers to enable more rural populations better access to health services.
This is a perfect example of how the power of partnership can leverage programs: the durable bicycles and trained field mechanics of World Bicycle Relief; the administrative and management expertise of Transaid, the design and manufacturing capabilities of Disacare; the caregiver networks of World Vision and CARE empowered by RAPIDS; and, of course, the funding of the Canadian High Commission. These organizations can come together with their respective strengths to help more people.
In the words of a community representative speaking at the distribution ceremony in Chipata “ What our friends have brought is beyond our imagination, we never thought a bicycle ambulance could be like this.”
Click here to see the March 2009 Final Evaluation Report of this Project.
Click here to watch a video of this project
*Disacare (www.disacare.org.zm) is a Lusaka based organisation that manufactures durable mobility aids for people with physical disabilities
