As we have established connections and reached out to local organizations and contacts over the past couple of months, our project has evolved with the feedback we have been given. Due to vast distances, cultural norms and a serious need for durable transport, we have shifted our focus to an outfitted motorcycle ambulance which is better suited for the harsh Sudanese terrain. But just placing a motorbike ambulance in rural Sudan is not enough to solve maternal mortality, so the project is taking a more holistic approach through both the emergency transport scheme and an mHealth system which will better educate pregnant women and traditional birth attendants through regular text messages, foster better communication between the health center and the community, and ensure that emergency transport can be deployed as early as possible.
There are four main stakeholders who need to be on board for this project to be successful. First are the pregnant women themselves. In order to encourage their participation, the project will need to convey the benefits of enrolment. Women will receive regular text messages with tips and reminders to help them feel more confident about their pregnancy, and they will have opportunities to privately ask questions to a trained midwife. These interactions throughout the duration of her pregnancy will build trust and promote transparency so that she will be more willing to be transported to a health facility if she chooses to deliver there or when a complication arises.
Second, the traditional birth attendants (TBAs) will play an integral role in ensuring the success of this project. The goal is to empower the TBAs to be better educated, better supported and to work alongside the health center, instead of in competition with it. In order to do this, the project recognizes the skillset of the TBAs who bring invaluable experience of assisting deliveries at the community level. Through regular trainings and SMS communication, the TBAs will be better integrated into the overall health system and will be an essential link between the community and the health facility. TBAs will be incentivized to refer women to the health center and to call for emergency transport because the project will guarantee that they will not lose income due to this new facility-based delivery approach. The payment offered will promote accountability and solidify their place in the overall healthcare structure.
Third, midwives, nurses, doctors, the health facility and the Ministry of Health need to be on board to work within this proposed structure. Since the government of Sudan has been supportive of projects aimed at addressing high rates of maternal mortality, this project focuses on this momentum to continue toward the goal of safe deliveries for every woman. The health centers will benefit from increased communication between themselves and the community to encourage women to seek services early and not wait until the onset of an emergency.
And last (but not least), are UNFPA, partner organizations, donors, and you! Every mother, everywhere deserves the right to the safest delivery possible. An intervention like this one can make that happen. Partners are needed to work together with the community to implement the mHealth system and to ensure that the motorcycle ambulance is affordable and accessible and reaches those who need it the most. Helping women in rural Sudan gain access to quality healthcare is a human right and is not possible without support for new, innovative projects like this one.
Using low-cost, low-tech solutions in rural contexts are not usually flashy or awe-inspiring, but if they are implemented using local know-how and buy-in, they are the most sustainable and helpful type of programme that can be put into place. It is for this reason that our team is going forward with the idea of a bicycle ambulance that can transport pregnant women from their homes in rural Sudan to health centres. In order to ensure that our idea is useful, we have based our project on two aspects of sustainability and one aspect of scalability.
Similar projects have been previously carried out in other African contexts (see previous posts for more information) and have proven to be successful. We are therefore moving forward with this project based on the assumption that similar achievements can be made in Sudan. By basing our idea off of successful projects carried out in similar contexts, while also adding new innovations to make the ambulance even better, we can be more sure of the overall success of our project. The most important feature of our design will be its durability and strength to withstand high degrees of environmental stress in order to avoid the need for frequent repair. This is the first step in making sure our idea is sustainable: proven effectiveness and product quality.
In order to ensure their sustainable use in communities, ambulances will be given to traditional birth attendants who are already based in each community so that they will be easily available in times of emergency. By using existing community practices instead of implementing a complicated and alien system, we hope that communities will more readily accept the ambulance for the mere fact that they know how to use it. This is the second step in making sure our idea is sustainable: ensuring local buy-in.
Scaling up the use of our bicycle ambulance in communities across Sudan will be relatively easy seeing as terrain and infrastructure is quite similar across the country, thus reducing the need to make alterations to its design. This will also be aided by the fact that our product can be easily delivered, due to its size, and will be able to be attached to a wide range of bicycles and possibly other modes of transportation such as motorbikes. Its versatility means that each community will be able to use it with tools already present in their communities, reducing the need for training. This is how we will ensure our idea is scalable: simplicity and versatility of use.
Our group seeks to innovate in a way that ensures that a functional and practical solution to the problem of transporting women to health facilities in rural Sudan is the product of our 10-week challenge. We therefore consider sustainability and scalability to be of great importance and will continue to ensure that both of these are included in our project.
Our project was locally focused and community based from the onset. During our first weeks of research, brainstorming and innovation-seeking we paid special attention to the reality of Sudan to come up with ideas and solutions that are feasible, in touch with lived experiences and culturally specific.
We are currently establishing communications with the UNFPA office in Sudan; we thus hope to be able to get in touch with experts, humanitarians workers and midwives presently working in Sudan. They will provide us with crucial information about a myriad of topics. Although our questions and inquiries may seem like details, these factors will determine the viability of the project in rural Sudan and its use by our target-users, in our case, women in need of emergency obstetrics care.
The challenge given to us was to reduce the delay between the identification of pregnancy-related complications and the arrival of women to a health centre. Based on our literature review and understanding of different case studies in Sudan, we have come to the conclusion that the delay arises when trying to find a transportation option to bring the women to health clinics or hospitals. The previously developed idea of using bicycle ambulances as a decentralized and sustainable means of transportation for women is thus becoming more concrete.
Using similar projects developed in other African countries as examples, we have identified that bicycles can indeed be used to facilitate transport of women in rural areas between villages and the closest health centres. In our programme, bicycles would be available to a set of communities. They are low-cost and, as they do not necessarily require importation of foreign technology, fairly easy to obtain. We strive to ensure that our project will be culturally sensitive, based on the reality of women in rural Sudan and that it will empower women and communities. For example, we have thought of providing instruction guides made with pictures or illustrations for the bike or the medical equipment knowing that they will be used by individuals who cannot read.
Our team will keep you informed of our progress and hopefully will have equally positive news to give in our next update!
Our team is working in association with the United Nations Population Fund (UNFPA) on a project that will address the issues surrounding maternal and neonatal care with respect to emergency transportation in rural villages of Sudan.
Briefly put, maternal mortality is a major issue in Sudan, particularly in rural areas, for which issues with transportation and communication cause more than half of the deaths. For the purpose of our pilot project, we aim to focus within the Northern Darfur region upon having identified various healthcare facilities in the vicinity of the local villages. We plan to utilise local resources and know-how in order to innovate, or at least repair, the “product” component of our potential program.
We hope to connect pregnant women with their closest healthcare facilities in advance in order to help appropriately regulate the availability of emergency services – especially for women experiencing complications and those in need of emergency transportation. Additionally, we hope to incorporate the use of mobile technology to help communicate essential educational information regarding immediate traditional treatment strategies. This part of the program is aimed at facilitating communication strategies that will help improve preventative and curative measures related to such emergencies. Another possibility we are exploring is the adoption of a non-pneumatic anti-shock garment (NASG), an anti-haemorrhage suit, that helps reduce excessive bleeding and ultimately helps prevent buy time during which the patient can be transported to a health facility.
We will further explore the possibility of using local basket weaving techniques, one of the prime activities among the female population in the selected region, in order to create the NASGs using this local material and expertise. We are currently investigating the possibility of introducing motorcycle, bike and/or rickshaw ambulances to address the transportation issue, as a low-cost and sustainable method of investment.
There have been some similar previously implemented projects in countries across Africa and the world (Southern Sudan, Zambia, Uganda); we hope to further analyse their strategy and test the potential of this idea in the context of Sudan, particularly in Northern Darfur. Over the next couple of days we have a few creative seminars and email/phone interviews scheduled with medical doctors, field specialists, social innovators and fellow student participants. Upon performing the aforementioned qualitative methods of research, we will further streamline and finalize our potential solution to the issue of maternal and neonatal care with respect to emergency transportation in remote Sudanese villages.