A GNA feature by Fatima Anafu Astanga

Bolgatanga, March 30, GNA - The role of transportation in the prevention of maternal morbidity and mortality is pertinent. Lack of a robust transport system makes it difficult for a number of medical facilities to handle emergencies. Consequently many medical situations get out of hand leading to needless deaths. Obstetric emergencies especially at the family and community levels and the long distance between health facilities and patients makes the situation very gloomy.

Delays to health facilities due to transportation problems cannot be compromised as the country strive to achieve the Millennium Development Goal four (4) and five (5).

The MDGs adopted as a framework for measuring development progress have not made particular reference to transport despite the importance it has on the efficiency and effectiveness in health delivery and other development sectors.

No doubt President John Evans Atta Mills have taken note of this problem and expressed concern about it when he visited the Upper East Region on a three-day working tour.

Accessibility, speed and Ghanaians ability to afford transport cost for services are becoming a growing concern for all. This involves families' inability to organise money to pay for transport fares at the community level during health crisis, the distances and type of transport within the reach of people.

Well is quite heartbreaking when the staff of a medical facility looks up to a client and say 93if you had come earlier the situation would not have gotten out of hand. Your patient bled to death". According to Dr Ana Elena Lopez of the Bolgatanga Regional Hospital, 25 per cent of maternal deaths that occurred at the hospital last year were due to bleeding or haemorrhage.

Records from the hospital gives a worrying figure of between 17 to 25 per cent of referred patients from districts dying before 24 hours.

Transport form an integral part for safe and effective health delivery. Dr John Koku Awonoor-Williams, Regional Director of Ghana Health Service said 93the slightest delay in an obstetric emergency can result in the loss of two or more lives per single birth episode". He indicated that these categories of deaths were unacceptable including hypertension, anaemia, unsafe abortion and obstructed labour since they were conditions that were preventable because the technological know-how exists to handle them.

The hard-to-reach rural communities in most parts of the country deserve a more vibrant standby transport system to handle health problems.

Although the available of ambulances help solve the problem, however, the services are compromised by distances and poor route conditions that have negative impact on referred cases for medical attention.

In East and West Africa, local means of transport such as donkey carts and bicycles are well adapted for safe transport and reliable transportation of emergency obstetric cases.

These means of transport however, come with lots of discomfort with effect to obstetric emergencies. Even though lots of pregnant women have been saved through this mode of transportation a lot have lost their lives or sustained critical injuries due to the poor handling and positioning of patients, particularly pregnant women. In Ghana, especially in the northern sector, donkeys, motor bikes and bicycles have been the commonest forms of transport in most rural communities.

The existing national ambulance and referral services which are available in most health facilities in the country are still constrained because of the nature of the rural terrain. We therefore cannot forgive ourselves as a country in this modern auto mobile engineering age. The challenge is that a number of rural communities cannot access these services or are unable to call for ambulance services.

To attain the MDGs health there is the urgent need for Ghana to come out with innovations to suit every health worker and the terrain of medical facilities with a sustainable transport system. In this way health facilities would be preventing a lot of maternal and neo natal deaths that continue to affect the performance of the health sector.

It would also encourage families in the rural areas to respond to health issues.

The Community Health Improvement Services (CHIPS) compound idea that makes provision for a CHIPS compound close to every community is timely but should be supported with adequate standby ambulance services to respond to emergencies.

There are reported cases in the Upper West and Central regions of some forms of community transport arrangements in place to ensure that pregnant women in labour are immediately transported to the nearest skilled health facility.

Personnel of the Ghana Private Road Transport Union is assisting the health innovation by not wasting time or asking for money before conveying patients to hospital.

There is therefore the need for the District Assemblies to support by making available standby vehicles to respond to serious health problems.

This should be coupled with good maternal and child health care such as antenatal and postpartum by health professionals. Pregnant women should also give birth in the presence of skilled attendants, and the availability of emergency obstetric services to encourage people to go to the hospital when the need arise.