Rural Transport and Development

Community Stretchers in Nepal provide vital health link
A Pilot Project to evaluate the impact of community managed stretchers on access to healthcare




In rural areas of Nepal where there are no roads and motorised transport is not an option, simple stretchers can provide a vital means of transporting sick and injured people to health care facilities. Funds raised by the Women in Transportation Seminar London (WTS) have been used to place stretchers in the heart of rural communities in 3 districts of Nepal, where they are being managed and maintained by local groups in order to improve their own access to routine and emergency medical care.

Research carried out by Nepal’s District Roads Support Programme as part of IFRTD’s Mobility and Health Networked Research programme identified that disadvantaged groups, primarily women and discriminated castes, tend to live further from the road and from health facilities. Strategically located stretchers therefore have a huge potential to benefit these groups, who are isolated by their situation and poverty.

This WTS funded pilot has enabled the purchase of 50 stretchers to be used across 3 districts of Nepal: Dolakha, Ramechhap and Baglung. The Rural Health Development Programme (RHDP) identified disadvantaged groups in each district to receive the stretchers to ensure that the neediest communities would benefit. The recipient communities then signed agreements with the RHDP for proper use and maintenance of the stretchers and to monitor their use.

Dolakha District
20 stretchers were distributed in Dolakha District to disadvantaged communities in Bhirkot, Lapilang, Suspa, Bulung, Khare, Laduk, Lamidanda and Ghyangsukathkar villages. The stretchers are kept by the disadvantaged groups and handled by Female Community Health Volunteers and Mothers Group members. Norms and guidelines for the use of the stretchers and how they should be handled in an emergency were developed and provided.

Most local people have appreciated the provision of stretchers free of charge for the disadvantaged sections of their community. Local health workers have reported that the stretchers are predominantly used in delivery cases. With the help of a stretcher it is easy to carry pregnant women to the nearest road and then send them by public bus to hospitals based in the district headquarters.

Ramechhap District
20 stretchers were allocated for distribution to disadvantaged groups in Ramechhap . An RHDP visit to Sunarpani and Manthali monitored use in 3 locations and found the stretchers being used in emergency cases i.e accidents and maternity, to carry the patient to higher service centres.

Management of the stretchers was found to be good; they are stored in a safe place and maintained properly. The groups have established their own regulations. For example in Mathali Ward #1 the Shree Durgeswar Mother’s Group charge Rs5 from users to maintain the stretcher. Similarly Koiralbot Mother’s Group charge 50Rs from users for the purchase of new stretchers.

Users found the stretchers were easy to carry, saved time versus making dokos and dolis (traditional carrying basket and hammock), were perceived as safe by patients, were easy to access as they belong to small groups.

“It was comfortable during the transport and saved time to reach the hospital following my leg fracture”

Mr Krishna Shresth age 65.

Baglung District
The ten stretchers donated to Baglung district are to be distributed between two different road corridors where the Decentralised Rural Infrastructure and Livelihoods Programme (DRILP) works. The stretchers ear marked for the Baglung-Bhurtibhang groups are already in use but the distribution of stretchers to the Kushmisera road is delayed until work starts on that stretch of road.

The interim report provided below gives examples of stretcher use in the various districts using the records provided by the stretcher user groups. Further evaluation will be available from January 2010.


Resources:

Interim Report (Download Word 3.5MB)
Stretcher Use Guidelines (Download Word 25 kb)
Sample Stretcher Use Agreement (Download Word 23 kb)

Links:
District Roads Support Programme http://www.drspnepal.org
Women in Transportation Seminar London http://www.wtslondon.org