In May 2016, Afiya, a 22-year-old pregnant woman from northern Togo, died after childbirth. Her death was preventable and inexcusable. Many factors contributed to the loss of this young woman’s life, among them a weak healthcare system that overlooked complications, lack of financial means, and gender inequity. All of them were avoidable. All of them are barriers Hope Through Health actively works to remove.
Afiya lay in a bed at a public health center in the remote village of Sarakawa for five hours after giving birth, in need of a blood transfusion and higher-level care. She passed away 15 minutes after arriving at the hospital, after hemorrhaging for an hour and a half riding on the back of a motorcycle along bumpy, unpaved roads. If suitable emergency transportation had been available, it may have given her a fighting chance.
Inspired by this tragic and needless loss, Hope Through Health began to explore interventions that could remove transportation as a barrier to a safe birth. The Rural Ambulance program is one solution. Hope Through Health’s Integrated Primary Care program serves 40,000 people in northern Togo by seamlessly integrating community health workers with public health centers. While the program is seeing positive results, still only 75% of women are delivering in the health facility (up from 36% at baseline, but not yet at the 85% target). Mothers from the community have shared with Hope Through Health that distance and lack of transportation are the biggest barriers. Women live as far away as 18 kilometers from the nearest health facility. Appropriate vehicles are extremely hard to come by, and even motorcycles are scarce in the most remote areas.
The Rural Ambulance program is designed with these women in mind. Hope Through Health proposes purchasing three motorized cargo wagons and adapting them to serve as ambulances by installing a small cot and bench in the back and a roof covering. The ambulances will be kept at three rural health centers and will ensure proper transport of in-labor women from their homes to the health center, as well as from the health center to the regional hospital. Hope Through Health will hire part-time drivers who are chosen by the community to be on call to respond to emergencies. Hope Through Health will cover all maintenance and gas expenses for the ambulances and will pay the drivers on an hourly basis. Women in the community will be able to reach the driver by calling the health center. Hope Through Health is hoping to procure the cargo wagons and begin recruiting drivers as soon as possible.
If the ambulance program had been in place following the complications from Afiya's delivery, she may have been transported to a local hospital in time to receive a lifesaving blood transfusion. An Integrated Primary Care Rural Ambulance Program would prevent inexcusable deaths like this from happening in the future.