For Kaniharin Bai, a resident of Koyilari village in the Naxal-affected Kabirdham district, Chhattisgarh, the nearest primary health centre is 12 km away in Daldali village. All through her pregnancy, this woman from the indigenous Baiga tribe feared would happen once she got into active labour.
Recalling how her relatives and friends suffered the ordeal of walking to the health centre in this hilly and rugged terrain under tremendous pain, she feared the worst. The possibility of delivering at home came with its own risk of complications.
On 7 October 2018, when she got into active labour, she called the number of the local motorbike ambulance driver, and within minutes, he was at her residence.
“It was a blessing that I didn’t have to walk down to the clinic with so much pain. Fortunately, the Sangi (translation: companion) Express driver and ASHA worker came to my doorstep, picked me up, and drove me to the clinic in Daldali, where the local doctor treated me. On 11.20 pm that night, my child was born safe and sound,” says Kaniharin Bai.
When Awanish Saran took over as the District Collector of Kabirdham district in April 2018, he saw a healthcare system that could not reach those most in need, particularly vulnerable citizens of the Baiga and Gond tribal communities.
“Government four-wheeler ambulances couldn’t reach or serve the community on time due to geographical constraints. Beneficiaries had to pay out of their own pockets and opt for private vehicles to seek health services. If they could not afford it, they would risk their lives, trying to reach the nearest health centre,” says Awanish, speaking to The Better India.
To address this shortcoming in the delivery of basic healthcare services, District Collector Awanish Sharan formulated a system of bike ambulances.
By any measure, this isn’t a novel initiative. In the Maoist-affected region of Bastar, for example, the Central Reserve Police Force (CRPF) used a similar system to offer immediate help to a sick or injured person backed by armed security personnel. However, Awanish felt that this could work in his district as well.
There are four key objectives of the Sangi Express initiative:
1) To decrease the maternal, infant, and child mortalities by commuting those who need emergency care within the Golden Hour.
2) To provide Emergency Response Services (ERS) commutation facility to accident victims, and those suffering from other trauma cases.
3) To reduce migration of villagers to other districts and connected states for seeking health services, and availing health services at the respective areas.
4) To strengthen the antenatal, intranatal, and postnatal care to pregnant women and newborn children under the Janani Suraksha Yojana (JSY), a safe motherhood intervention under the National Rural Health Mission, and act as a bridge to provide primary care to all.
“Surrounded by hills, many areas of Kabirdham district have suffered from the lack of access to basic healthcare facilities, particularly Pandariya and Bodla blocks. The population is scattered and commuting is a big challenge during the monsoon seasons, due to which basic antenatal and newborn care services are comparatively difficult to provide. This leads to deliveries at home in these areas. This poses a risk to the lives of both mothers and newborns,” says Awanish.
Besides, there was also the challenge of unavailability of human resources (medical officers, particularly at the primary and community health centres). In the district hospital, meanwhile, there was a lack of specialist doctors.
After addressing this shortfall in staff, the district administration came together with the Anganwadi workers, ASHA workers, and the local Gram Panchayats to spread awareness among locals regarding the Sangi Express initiative.
On 15 July 2018, the district administration launched this initiative in the villages of Kukdoor, Daldali and Bokarkhar. After receiving positive responses and acquiring good results, it was replicated in two more villages—Jhalmala and Cheerpani on November 1.
After initial hiccups, the motorbike ambulance service began working round the clock.
How does it work?
The beneficiary contacts the PHC, the CHC in-charge (Community Health Centre) or motorbike ambulance driver through the Anganwadi or the ASHA (Mitanin) Worker on a number specific to a village, which is widely distributed by the local panchayat to each household. This information is disseminated during meetings and awareness-raising sessions, where local officials talk about the usefulness of motorbike ambulances.
Each village has one motorbike ambulance, which reaches the beneficiary’s doorstep so that they don’t have to bear the cost of paying for private vehicles, and avoid the pain of walking.
In the ambulance, you have the beneficiary, an attendant (usually a relative), the ASHA worker and driver, carrying all first aid supplies and protective helmets. They are transported to the nearest health centre, where they receive treatment.
Once treated, the patient is transported back to their home in the same ambulance. These services are free of cost.
“Besides offering immediate care, this initiative has given employment opportunities to locals. Drivers of this ambulance service are from the respective villages. These boys are ‘one of their own’, thus making it easier for locals to utilise these services. An advantage of a local boy on the wheel is that they are familiar with the geography, and can find the fastest or shortest route to arrive at a government health facility,” says Awanish.
The impact of the Sangi Express has been real. Since 15 July 2018 to 31 May 2019, the total number of institutional deliveries have been 346, while the number of children brought for antenatal check-ups is 1,120, according to district-level data.
Only in 11 instances, the PHC or CHC were forced to commute patient cases to seek a higher level of health services. More importantly, however, the district magistrate claims that these motorbike ambulances have reduced out of pocket expenditure by a whopping 90 per cent!
“The successful implementation of Sangi Express has not just resulted in incremental health improvements but also helped and empowered women to understand the concept of ‘Right to Health’. It has boosted their confidence to seek health facility with ease,” concludes Awanish.
(Edited by Shruti Singhal)