Impact of Transport on Access to health services for PLWHA in Namibia
Transport has a crucial role to play in increasing Namibian communities’ access to health service, particularly for people living with HIV/AIDS (PLWHA). An assessment 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
- Lack of appropriate and affordable transport solutions hinders individual access to health facilities and movement of health workers.
- Transport costs combined with medical fees represent a burden to PLWHA, particularly women, who might spend between 6 and 10 US dollars every month to collect medications.
- Lack of money to pay transport costs has direct impact on treatment adherence.
- Although five km or one hour walking is considered the reasonable distance to access treatment by community members, seventy-seven per cent of participants in the research living in rural areas are more than 20km away from the nearest health facility.
- Transport is an important but yet underestimated component for decentralisation of drugs distribution system.
- Lack of affordable and reliable transport is a barrier to emergency care, and transport in an emergency situation depends solely on patient’s capacity to access cash. In rural areas, it might costs up to 65 US dollars to reach hospital timely. According to community members and health workers, “patients get exhausted and even die while waiting for an ambulance”.
Funded by Yelula/U-khâi, the National Paralegal Association, and with the technical support of GEO Business Solutions, this was the first assessment conducted in Namibia linking access to transport and access to health services. The geographical focus was on Omusati and Karas, two regions with important typological differences in the country. Omusati, characterised for being a communal region in the border with Angola, is one of the most populated regions in the country, with more than 12 people per km2. Field researchers collected data in the capital of the region, Outapi, as the urban site, and the town of Ruacana on the Angolan border as the rural. The southernmost region of Karas has less than one person per km2, and is formed mostly of commercial farms. Data was collected in Karasburg constituency, with the town of Karasburg as the urban focus, and Aussenkehr, a cluster of grape farms on the South African border, as rural. The sampling was designed to reach key informants on the demand side (transport users) and service provision side (transport and health service providers). It also included local authorities at constituency level.
Namibia is one of the youngest and most stable democracies in sub-Saharan Africa. Since its independence in 1990, the Government and the international community have made an enormous effort to change its position as one of the most unequal countries in the world, currently at 0.6 Gini Co-efficient. Despite the efforts to date, the legacy of apartheid pervades Namibian life and the majority of the black population still lives in poverty. The country has one of the world’s lowest population densities with less than two million people in an area of about 2.5 times the size of Germany. More than 60 per cent of the population lives in the Northern regions, and about 65 per cent inhabits rural areas (NHIES 2003-04). What characterises the rural setting are distances between villages, homesteads, schools, clinics, markets and churches. Namibia is a country of great inequality and vast empty spaces.
Difficulties with distances are exacerbated as Namibia faces the combination of ineffective social services delivery and a staggering 19.9 per cent prevalence of HIV/AIDS amongst the adult population (2006 National HIV Sentinel Survey). The health system has struggled to cope with the number of people admitted to hospitals with AIDS-related illnesses, but the shortage of health workers remains a hindrance. In rural areas, lack of appropriate and affordable transport systems and infrastructure isolates communities from access to health services.
Since 2005, BEN Namibia has discussed the relationship between transport and community-based health care initiatives, particularly home-based care (HBC) and support to orphans and vulnerable children. Community-based activities as such constitute an important support to the national health system, alleviating the burden on doctors and nurses, and involving trained volunteers on palliative care, as well as physical and emotional support of people infected or affected by HIV. Partnerships with more than 30 community-based organisations focused on distribution of bicycles and bicycle ambulances to volunteers in Northern, North-Eastern and Central parts of the country. Eighty per cent of Namibian’s community volunteers are women and lack of appropriate transport solutions is one bottleneck for the effectiveness of their work (MoHSS, 2006). Monitoring data from BEN Namibia’s partnerships, combined with previous studies on access to health services in the country, reveals that transport has an important role in increasing disadvantaged communities’ access to treatment, care and support. As a result, it became imperative that an assessment was to be carried out for the first time in Namibia in order to establish the impact of transport on access to health services for PLWHA. Its main outcome was to open the debate about the relation between access to health vis-à-vis access to transport, identifying areas for potential initiatives.
The research approach was recognised in the country by the HBC Forum in Oshakati, by the Deputy Minister of Health and Social Services, and by the sub-committee on HIV/AIDS from the Parliamentary Standing Committee on Human Resources, Social and Community Development of Namibia.
For more information about the assessment, please contact:Clarisse Cunha
BEN Namibia – Programme Coordinator
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