Last year, my father suffered a massive stroke at home in Accra, Ghana while I was in the US. It was late afternoon on a Sunday, and he and I had just finished talking on the phone about the dismal performance of the Ghana Black Stars at the 2014 Football World Cup in Brazil. He went to the restroom, but when he failed to return after a few minutes, my mother went to check on him – only to find him collapsed against the toilet bowl with his glasses in his left hand, unable to speak. She immediately called out for assistance. Kwaku and Shirlee rushed to help move him from the bathroom to the bedroom. He felt like a dead weight to them. No wonder; half of his body was paralyzed.
Just as this was unfolding, my father’s closest friend, a physician, happened to drop by for a visit. Uncle Yaw quickly recognized that my father had had a stroke and called for the ambulance from the private clinic right behind my parents’ house. Since it was a Sunday, the ambulance driver was not available. But the clinic owner was willing to let them use the ambulance if they were willing to drive it themselves and reimburse him for fuel.
They quickly bundled my parents and Shirlee into the back of the ambulance. Uncle Yaw and Kwaku managed to figure out how to operate the ambulance and drove it all the way from East Legon to Korle-Bu Teaching Hospital, on the opposite side of Accra. It took less than 20 minutes for them to cover a distance of 16 kilometers, with sirens blaring. Uncle Yaw called ahead to the hospital so that upon arrival my father received prompt diagnosis and treatment. He was discharged from the hospital two weeks later and has been recovering quite well since then.
We were lucky. My parents happen to live in Ghana’s capital city, Accra. Uncle Yaw happened to visit just after the stroke occurred. Our house happens to be behind a private clinic, which happens to have a standby ambulance for urgent referrals. The private clinic doctor was kind enough to trust us with hisambulance; traffic was light, as it was a Sunday afternoon.
Most families in Accra are not lucky enough to have the stars align so well during a health crisis. And for families in the rural areas, this type of alignment is all but impossible. This is because in the rural areas, urgently sick people trying to get to a hospital face distances of more than 30 kilometers or more than a 4-hour walk, impassable roads, few motorized vehicles, unreliable transportation service, and lack of money to pay for appropriate transportation.[i] This is one of the major reasons the rate of premature deaths in rural Ghana is high, especially for the most vulnerable members of the population—pregnant women and young children.
While the government of Ghana has been gradually improving the rural road network, broadening the geographic reach of health care facilities, and increasing the number of health staff in the rural areas, we are still far away from having sufficient density of hospitals, health care professionals, and ambulances in the rural areas to get sick people to appropriate health care on time. Yes, the Ghana National Ambulance Service was established in 2004 and has grown to have roughly one ambulance that is staffed with trained paramedics in each district. But the population of a health district may be as many as 150,000. And the ambulances are located at the district capital, far from the remote rural communities, and are mostly used for emergency referrals from clinic to hospital. Moreover, the complexity of the ambulance engines is such that they have to be serviced at the regional capital, even further away from the remote rural areas. Finally, the rough roads in the remote rural areas are challenging for these ambulances due to low ground clearance.
So what do most rural families do? They rely on private means of transport just like their urban relatives, except that in many rural settings, especially in the north of Ghana, motorized transportation is scarce. Where it does exist, it is most likely a motorcycle, which is not safe for transporting sick people, especially women in labor. Urban minivans and trucks ply the main roads on market days, but they are difficult to find on non-market days and are prohibitively expensive (as much 100 Ghana cedis or 27 US dollars) to hire to transport a single sick person. This means that many rural families do not even attempt to seek care for urgent health needs – or they only show up when the situation is dire after all home remedies have failed or they have finally been able to secure affordable transportation. Take the common example of a pregnant woman in labor sitting on a motorbike for an hour only to deliver a stillbirth; or a father carrying his sick child in his arms while walking for two hours under the scorching midday sun, only to have the child die within minutes of arrival at the hospital. These tragedies are daily occurrences in the rural areas of Ghana and other Sub-Saharan African countries.
MAZA, a new social enterprise established in Ghana in April 2015, was created to reduce the frequency of such needless deaths – by providing an innovative transportation solution at the community level that is affordable, accessible, safe, and reliable. MAZA, which means “quickly” in Hausa (the most widely spoken language in West Africa), achieves its goal by increasing the supply of multi-purpose passenger motorized vehicles at the community level, while ensuring their availability and reliability for urgent health transportation through a roster system, powered by mobile technology.
Figure 1: How MAZA functions
Here’s how it works: MAZA subsidizes the cost of motorized tricycles for drivers who “work-and-pay” to own the vehicle over a two-year period. In return, the drivers agree to be on call for health transportation two days a week; otherwise, they are free to use the vehicle for other income-generating opportunities. MAZA structures demand for health transportation with health education, subscribing families through various incentives, and using mobile money savings in order to eliminate concerns about affordability and the associated delays during an urgent health crisis.
In partnership with the Ghana National Ambulance Service, the Ghana Health Service, and the National Catholic Health Service of Ghana, MAZA seeks to transform how families prepare for health crises at the community level and how quickly they can access skilled health care in the event of a health emergency. MAZA launches in December 2015 in Chereponi District in Northern Region. Women in this district, with a population of about 53,000, seek health care at high rates during the antenatal period – but not during labor and delivery, the most vulnerable period for both mother and baby. This is not because of the cost of clinical care since national health insurance in Ghana is free for maternal and newborn health care. Rather, this is mostly because they lack access to safe, reliable and affordable transportation to get to skilled health care. Chereponi has only seven skilled birth attendants – a medical doctor and five midwives at the district hospital and an additional midwife in a health center about 20 kilometers away. MAZA’s goal is to close the gap between care-seeking during the antenatal and delivery periods through its urgent health transportation solution at the community level.
I recognize that my family was lucky when my father had a stroke; many things came together to get him to quality health care quickly. MAZA is working hard to fit together all the pieces of the urgent health transport puzzle so that families in the rural areas do not have to rely on luck alone.
[i] Gething PW, Johnson FA, Frempong-Ainguah F et al. Geographical access to care at birth in Ghana: a barrier to safe motherhood. BMC Public Health 2012;12:991
The author is the founder and CEO of MAZA. She can be reached at email@example.com.
You may learn more about MAZA at www.mazatransport.org.