This is the second in a series of blogs that profile winners of the Resolve Award, given by the Aspen Institute Global Leadership Council for Reproductive Health. The Resolve Award celebrates innovative efforts to expand access to family planning and reproductive health services.
When Majai Ceesay gave birth to twins in June, 2012, it was a difficult labor. Delivering the first twin drained her strength; dehydrated and in pain, she was too weak to push for the second birth. She feared for the worst: in Kanikunda, the remote Gambian village where Ceesay lives, a difficult delivery has often been a death sentence.
But Ceesay was in luck. Sheriff Darbo, a community health nurse, travelled to Kanikunda by motorcycle to attend Ceesay’s birth. He administered oral rehydration solution and sugar to boost her energy, as well as medication to relieve the pain. With that intervention, Ceesay regained strength and her contractions became powerful. Two hours later the second boy was born alive.
“I can honestly say that without Sheriff, I and my second twin wouldn’t be alive,” says Ceesay.
Ceesay’s predicament was not unusual. In rural areas throughout the developing world, thousands of women and infants lose their lives in childbirth because health care is simply inaccessible. Bad roads, unreliable vehicles, fuel shortages—these are among the challenges that confound efforts to make sure all people have access to quality reproductive health care.
Health outreach workers like Sheriff Darbo now have motorcycles that enable them to visit three times as many villages each week, and spend twice as long in each community.
But Ceesay’s story had a happy ending, thanks to an innovative partnership between The Gambian government and my organization, Riders for Health. Through this partnership, Sheriff Darbo was provided with a Yamaha AG100 motorcycle, which enables him to make many more visits to the remote villages within the 100 mile area he covers.
A decade ago, The Gambia struggled to maintain its fleet of ambulances and other health transport vehicles. Government staff lacked the expertise to maintain the vehicles, which took a beating on our rural roads; less than one fifth of the Gambia’s roads are paved.
So, a few years ago, The Gambian government and Riders for Health brokered a solution. With support from the Skoll Foundation, Riders for Health secured bank funding from the local GT Bank to purchase a new fleet of vehicles—ambulances, SUVs, and motorcycles. Riders for Health, which has two decades of experience providing health transport in Africa, is responsible for maintaining the fleet, and for training Gambian drivers, riders and mechanics. The Gambia’s Ministry of Health then leases the vehicles from us, paying a not-for-profit, fixed fee for the service based on the number of kilometers each vehicle travels.
The result? In 2009, The Gambia became the first African country with enough health-care delivery vehicles to service its entire population.
It is hard to overstate the difference this has made for our people’s lives and health. Remote rural clinics now receive regular visits from health workers, who can refer patients to the next level of care—and get them to the hospital before their problem becomes an emergency.
Health outreach workers like Sheriff Darbo now have motorcycles that enable them to visit three times as many villages each week, and spend twice as long in each community. That means more births are attended. More people learn about family planning, and about how to prevent mother-to-child transmission of HIV. More people learn how to control malaria, how to recognize the symptoms of tuberculosis, and about what to do if their child has diarrhea. And more than 90 percent of Gambian children are now immunized.
Our fleet of vehicles in The Gambia has logged some 10 million kilometers since 2009, without a single breakdown due to lack of maintenance.
Crucially, the program allows the Gambian health Ministry to offer reliable care, which is a cornerstone of public health. As a health care worker said to me recently, “I can say to a pregnant woman, ‘I’m going to come visit you on the first Monday of the month,’ and she will know that I’ll actually be there. If I tell her I’m going to come, but I don’t have any fuel or the vehicle isn’t running, and I don’t go, then the next time she won’t wait for me.”
For women in places like Kanikunda, that kind of early and regular contact with a health care worker could literally mean the difference between life and death. A referral to a hospital—and the means to get there—is a life-saving intervention that could greatly reduce the number of lives lost needlessly in childbirth.
The last mile between help and need is the most important one. In The Gambia, we are going the last mile to connect women and families with the care they need.