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Hope Through Health Integrated Primary Care Rural Ambulance Program

Hope Through Health eliminates preventable deaths by providing neglected communities with efficient and effective healthcare.

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In no more than 3 sentences, please tell us who your idea is designed for and how it reimagines the new life experience.

This project idea is designed for a woman in labor on the back of a motorcycle traveling over two hours across unpaved roads in rural Togo. While unimaginable by Western standards, it is a reality for many Togolese women, who may live more than 18 kilometers from the nearest health facility and a lack access to suitable, safe vehicles to make the trip. A simple vision, a motorized cargo wagon with a tent and a cot, can mean the difference between life and inexcusable death for mother and child.

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.

At what stage is your idea?

  • Research & Early Testing: I am exploring my idea, gathering the inspiration and information I need to test it with real users.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

A needs assessment has indicated the lifesaving value the emergency cargo trike would provide to mothers using our rural integrated healthcare clinics. Each clinic is already engaged in rigorous data collection protocols to track and improve the effectiveness of interventions. Data would be collected on each emergency transport. We also have examples of the outfitted emergency cargo trike used in Mali that can provide the model for physical construction of the ambulance.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

We're open to any insights, feedback or suggestions from the OpenIDEO community. The collective knowledge of such a savvy and dynamic group of global thinkers providing their thoughts and contributions to our idea is invaluable.

Tell us about your work experience:

Since 2004, Hope Through Health has worked in Togo to transform the dynamics of healthcare delivery systems. The model works by empowering community members to become health workers, providing clinical mentoring, offering capacity building for supply chain management, and eliminating user fees.

This idea emerged from...

  • A group brainstorm
  • An organization or company

Are you an expecting, new, or experienced mom?

  • no

Are you a healthcare practitioner?

  • yes

Are you a current employee of UCB Pharmaceuticals or Sutter Health?

  • no

How would you describe this idea (in 2-3 sentences) while in an elevator with someone?

In Togo, the reality of giving birth too often includes travel over two hours across unpaved roads, sometimes while in labor, in order to receive needed healthcare. Hope Through Health wants to change this reality by creating a rural ambulance program for pregnant women in labor or requiring an emergency intervention (i.e. complications with delivery, blood transfusion, etc.). By introducing a rural ambulance program for emergency purposes we can save a significant number of lives.

What is the specific problem your idea is trying to solve? 1 sentence.

Hope Through Health wants to eliminate transportation as a barrier for care in the delivery process.

How has your idea improved or evolved throughout the Refinement Phase?

The inspiration for the idea came from two events. The first was the tragic loss of Afiya, a young pregnant woman in Togo, who died after childbirth. This avoidable catastrophe left a significant impact on our team. In the search for answers we conducted a social autopsy. Many factors were revealed by this investigation, but introducing an ambulance program was the lowest lift that could be implemented in the shortest amount of time with the greatest potential impact. Second, a learning partnership with Muso, a peer organization in Mali, introduced us to their rural ambulance program in January 2017. Almost immediately we began exploring the possibility of creating a similar program in Togo. Through the refinement process, we have been introduced to new tools and comparable programs. The most useful was the User Experience Map. We applied our social autopsy to the process to consider how Afiya’s experience might have been different with this technology in place. In this instance, rather than creating a composite character to undergo the “user journey,” we followed Afiya’s journey to consider how different actions could have resulted in more favorable outcomes. Afiya was 22 years-old. She was pregnant, living with undiagnosed Sickle Cell, and malaria. She lived in a rural area, where her family struggled to survive in extreme poverty on less than $2 a day. We started the “experience” after Afiya had already delivered at the health center, since we have created programs to offset costs to quality care. We looked at how transportation to the hospital could have changed the outcome. Further, we looked at other program designs to see if they could help shape the project, including Health Access Connect in Uganda. In addition, we have been in touch with an organization called Masa Transport based out of Ghana who is working on rural ambulance services and willing to share lessons learned.

How do you plan to measure the impact of your idea?

Hope Through Health is a learning organization that relies on a data-driven model and implementation science best practices to inform everything that we do. Our research team reviews a range of patient metrics and related data to see how we can continuously improve our efforts in every area of work. This feedback loop provides a constant self-evaluating process that allows us to change strategy and improve patient outcomes.

What are your immediate next steps after the challenge?

Hope Through Health will purchase three motorized cargo vehicles to outfit as ambulances. We will identify, recruit, and train drivers to serve as the clinic’s ambulance service. We will continue to collaborate with Masa Transport and Muso for information sharing and collaboration. We will continue to collect data on patient outcomes and convene an evaluation meeting with stakeholders after the first month of operations.

How is your idea different or unique from what is currently on the market?

Hope Through Health is driven to combine patient centered care with universal access integrating a community health worker model with improved health clinics to ensure positive health outcomes.

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Photo of Kevin Gibbons
Team

Dear Josh,

Cool idea! The lack of emergency medical transportation is something we've been thinking about a lot at Health Access Connect in Uganda. We have a similar story from a woman whose baby died of complications but could have been saved if she could've been transported to a hospital.

In Uganda there ARE some ambulances, but they are rarely available or affordable, especially in remote areas -- often due to disrepair, lack of money for fuel, or absentee drivers.

We've just purchased motorcycle ambulance trailers that are manufactured by a Ugandan company Pulse: http://pulse.ug We are going to store then at rural health facilities so that. We're still trying to figure out the logistics of WHO can drive the trailers, HOW they can be made available at all times, HOW MUCH should be collected for maintenance, etc. Our organization doesn't have the infrastructure that HTH does; we just provide support services for government health facilities, which means we couldn't have the same kind of control over the vehicles and their administration.

What are your plans for the cost of operating and maintaining the trikes? And how could other health facilities in Mali use the same model and have it work in the long term?

Thanks for your submission! Congrats on making the short list.


Cheers,
Kevin

Our submission:
(Motorcycles + Midwives) -> Remote Villages: Monthly mobile clinics in remote villages of Uganda

Photo of Josh
Team

Hi Kevin, I'm sorry for your loss. Thank you for your feedback and sharing your case example. I enjoyed reviewing it & the other project in Uganda that you are connected with. Much appreciated. Best, Josh

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