PROJECTS: HEALTH & TRANSPORT ADVOCACY
Objective of the Health-Transport Advocacy Project
Advocate for appropriate, reliable and sustainable transport solutions to improve access to treatment and emergency care for PLWHA in Namibia.
- Disseminate research findings to grassroots groups and networks, e.g. HIV/AIDS support groups, home-based care groups, ICW-Namibia, so they can advocate for solutions appropriate to their reality.
- Liaise with Government offices and development agencies so analysis of access to transport and its ripple effect on access to health is part of their policy-making process and intervention-design.
Transport has a crucial role to play in increasing Namibian communities’ access to health services, particularly for people living with HIV/AIDS (PLWHA). Research conducted by the Bicycling Empowerment Network Namibia (BEN Namibia) in partnership with the International Community of Women Living With HIV/AIDS (ICW-Namibia) and the AIDS Law Unit from the Legal Assistance Centre (ALU/LAC), from August to October 2007, demonstrated that there is strong need for intersectoral initiatives to provide appropriate and affordable transport solutions to patients and health workers in the country.
Funded by Yelula/U-khâi, the National Paralegal Association, and with the technical support of GEO Business Solutions, the assessment took place in two regions. Omusati, a communal region on the northern border with Angola, is one of the most populated regions in the country, with more than 12 people per km2. The southernmost region of Karas has less than one person per km2, and is formed mostly of commercial farms. The methodology combined qualitative data collected at local and national level, and existing quantitative data. Focus groups and semi- structured interviews were conducted with informants on the demand and service provision side, as well as with local authorities.
As the first Namibian initiative focusing on the impact of transport on health service access, the assessment raised a range of issues that can be addressed at different levels. While the relationship between transport and health is clear, the route to solving transport problems is not so straightforward. Although there is wide awareness in Namibia that lack of transport is a barrier to accessing services, transport itself has always been treated as a peripheral issue. Since transport limitations have not been properly qualified or quantified, addressing them has never been a priority on the national agenda.
Lack of appropriate and affordable transport hinders individual access to health facilities. Transport costs combined with medical fees represent a burden to PLWHA, particularly women, who spend between N$20 and N$40 every month to collect medications, directly affecting treatment adherence. Participants in the research consider 5 km the reasonable distance to access treatment, however 77 per cent are more than 20 km away from the nearest health facility. Lack of reliable transport is a barrier to emergency care, when transportation depends solely on patients’ capacity to access cash. Rural dwellers pay up to N$400 to reach hospital in an emergency. Transport is also an important yet underestimated component in the drug distribution system. Initiatives to promote effective decentralisation such as mobile clinics and improved mobility for healthcare community volunteers are still ad hoc and uncoordinated.
Recommendations focus on the need to involve stakeholders at all levels of the supply and demand chain. Cooperation between health and transport policy-makers, local communities, health workers and PLWHA are crucial in order to develop a holistic approach to access to health services.