Mobilizing transport for obstetric emergencies in northwestern Nigeria

Abstract

Focus group discussions and a village case study in Kebbi State revealed delay in the transport of women with obstetric complications. Among contributing factors identified were shortages of vehicles and fuel, and unwillingness of drivers to transport women at affordable fares. The cooperation of the local transport workers union was enlisted to address the situation. In 1993, drivers were sensitized and trained and a revolving emergency fuel fund was established. Prior to these activities, emergency obstetric services at nearby facilities had been upgraded. Over two years, 29 women with obstetric complications were transported. Of these, only one died. Mean cost of transport to patients was US $5.89. Mean time from the onset of complications to treatment was 9 h. Substantial numbers of non-obstetric patients in need of emergency care were also transported. Although defaulting eventually resulted in depletion of the fuel fund, the reimbursement system had become sufficiently well-established that most drivers no longer requested funds in advance. Cost of the transport intervention was US $268, with 72% coming from project funds. Improving transport to emergency care does not necessarily require ambulances. Commercial transport owners and communities can be mobilized to provide affordable emergency transport for women with complications.