Feature by Fatima Anafu Astanga

Bolgatanga, April 4, GNA - The role of transportation in the prevention of maternal morbidity and mortality cannot be over-emphasized.

Medical facilities have been confronted with lack of efficient transport system to handle emergencies that cause many medical situations to get out of hand because the patient is sent to the facility late.

Delays due to lack of transport cannot be compromised as the country strives to achieve the Millennium Development Goals Four and Five. The (MDGs), which were adopted as a framework for measuring development progress, have not made reference to transportation despite its importance. Availability of transport can be a major influence in timely and affordable delivery of basic services including health and sanitation. The latter has become a great concern to the nation as the President saw when he visited the Upper East Region on a three- day visit to the region. Accessibility, speed and Ghanaians' inability to afford transport cost for services are becoming a growing concern for all. This involves families' inability to pay transport fares at the community level during health crises, the distance and the type of transport within reach of the people.

Quite heartbreaking when the staff of a medical facility looks someone up in the face and says 93if you had come earlier the situation would not have got 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 over bleeding.

Dr Koku Awonoor-Williams, the Upper East Regional Director, Ghana Health Service, said the 93slightest delay in an obstetric emergency can result in the loss of two or more lives per single birth episode". He said unacceptable deaths caused by hypertension, anaemia, unsafe abortion and obstructed labour are conditions that are 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 this health problem.

This is not to condemn the existing ambulance system that are provided by the districts but these services are compromised by distances and poor roads that have negative impact on referrals for health services.

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. However, they cause a lot of discomfort to obstetric emergencies. 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 poor handling and positioning of patients, particularly pregnant women. In Ghana, especially in the northern sector, donkeys, motor bikes and bicycles have be en the commonest mode 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. To attain the Millennium Development goal on health as a country, there is the need to come out with innovations to suit every health worker and the terrain with a sustainable transport system. In this way health facilities would be preventing maternal and neo natal deaths.

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

There are reported cases in the Upper West and Central regions of some form of community transport arrangement in place to ensure that women in labour are transported to the nearest skilled health facility by private vehicles through the Ghana Private Road Transport Union. District Assemblies should also support by making available, standby vehicles to respond to serious health problems. 04 April 11