I’ll admit that before I started working for the HSG Team as a summer intern, I would not have considered myself a “systems” person. Systems are boring, right? But now, only 6 weeks later, I find myself a full convert. It turns out everything is about the system.
When I began delving in to what it might take to improve access to emergency transportation in Kwitanda, Malawi, I thought I was going to learn about bicycle ambulances. Or lack of bicycle ambulances. Or broken ones. Or maybe even full-on motor vehicle ambulances with sirens and flashing red lights. But alas, I learned about systems.
It’s true that one of the major barriers to successfully accessing emergency medical services in resource-limited environments is the lack of reliable and affordable transportation between the location of the emergency and the nearest hospital. And in Kwitanda, bicycle ambulances are filling that gap. But when people need to get to a hospital in a hurry, the vehicle that takes them there is only one piece of the puzzle. First, someone needs to recognize the need to get to a hospital. Sure that may be obvious in the case of a serious accident, but it might not be in the case of a woman, giving birth at home, whose labor is taking a turn for the worse. Next, there has to be a way to notify the ambulance that there is an emergency and in a place with limited access to electricity and cell phones, this can be tricky. Once the bicycle ambulance is located, someone needs to drive it to the hospital, and equally importantly, bring it back so it’s available for the next emergency. In the best-case scenario, there would be a way to notify the hospital that a seriously injured or ill person is on the way, so that the hospital can be ready when s/he arrives. In short, there needs to be a system.
Luckily, the communities we work with in Kwitanda understand the importance of systems (and understood it much more quickly than I did, I might add). Currently, there are village committees in place to oversee the use and maintenance of the ambulances. In fact, the number of households that have “ever used” a bicycle ambulance saw a three-fold increase between 2010 and 2011. To keep seeing these kinds of results, we need to ensure that the systems, not just the ambulances, are working.