Transportation and Health Care Go Hand In Hand

In the MAHEFA regions of Madagascar there was often limited access to any type of affordable transportation. Many roads were poorly maintained and the terrain made motorized transport challenging. Regions exposed to months of rain are also inaccessible nearly one third of the year. This made preventive health care a challenge, not to mention urgent care.

In addition to introducing Community Health Volunteers (CHVs) to these rural communities, MAHEFA identified a greater need for emergency transport, ensuring that patients had access to treatments and care not always offered by smaller community clinics.

Several modes of transport were identified and introduced to help assist in urgent care needs. Bicycle ambulances, wheeled stretchers, canoe ambulances, and ox-carts were all placed within the communities. They were chosen according to the terrain and context.

Since implementing the multi-modal ambulances through MAHEFA, 253 drivers have been trained on emergency transport. 151 ambulances have been provided. 185,053 people now have access to emergency care through ETS.

Each emergency technician is responsible for the care and upkeep of their respective 'ambulance'. Identifying specific needs for bicycle ambulances, including bike parts and trained bike mechanics, MAHEFA sought to support the ETS on a more technical level.

EBoxes were established in four regions of Madagascar to help incentivize CHVs and also help physically support the ETS. The idea was to bring mechanics and spare parts closer to the ETS operation to help support and facilitate the use of these bike ambulances.

Through the sale of bikes at eBoxes, which received donated bikes from the UK and US, co-ops could help support the cost of the ETS as well as the bikes themselves. It was understood that each co-op would help fund the ETS and mutuelle (health insurance) through eBox profits. This synergy between community, ETS, mutuelle, and eBox was created in an effort to make this program sustainable.

Robin Erinesy operates his bike ambulance whenever called

Now, whenever care is needed, help is there. ETS makes transporting patients of every age and illness possible over any terrain or weather condition.

The mutuelle helps families afford transport, care, and medicines to help keep their families strong and healthy.

And the eBox is the micro-finance initiative behind the motivation and success of CHVs, ETS, and the mutuelle.