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Transport for Health Access

The adequate provision of and access to health care services that are necessary to meet the Millennium Development Goals (MDGs) for Health by 2015 depend on complex inter-sectoral linkages to which transport makes essential contributions. The transport sector affects the availability of both preventive and emergency care, potentially affecting service delivery rates. Transport is essential for the distribution of drugs, blood and other supplies to health facilities. It enables the timely transfer of patients between health facilities and to the different levels of care of health referral systems. Efficient transport systems and roads also facilitate access by health workers to often sparsely populated rural areas as well as the necessary monitoring and supervision of heath services and initiatives.

Distance combined with poor road access and lack of transport constitutes a considerable challenge for health access in developing countries. The World Health Organization (WHO) estimates that between 40 to 60 percent of the people living in developing countries live more than 8 km from a health care facility. Although health outcomes have improved in the second half of the 20th century, progress slowed down in the 1990s, and at the current pace, most regions of the developing world will not reach the Millennium Development Goals (MDGs) for Health by 2015. In Sub-Saharan Africa, the maternal mortality goal has actually receded over the past decade.

Over the past year, the World Bank’s Transport and Social Responsibility (TSR) Thematic Group has reviewed some of the evidence on the role of transport in improving health in developing countries, primarily focusing its efforts on linkages between the transport and the health sector to reduce both child mortality (MDG4) and maternal mortality (MDG5). The literature shows that, particularly in rural areas, considerable time is spent by women and their families waiting for transportation and traveling to a health facility. In addition, poor roads, too few vehicles and high transportation costs are major causes of delay in deciding to seek and reach emergency obstetric and postnatal care. Limited evidence, often restricted to a group of villages or a district, makes overall comparisons between interventions and across the various levels of referral difficult.

The role of transport in combating
 HIV/AIDS (MDG6) is being investigated separately and was a featured theme in the Bank activities to mark World AIDS Day, on December 1, 2006.

Health impacts resulting from transport mode choice and travel patterns are also significant. They include cardiovascular diseases (from reduced physical activity due to increased motorized travel), respiratory diseases (from atmospheric pollution), impact on mental health (from traffic congestion, noise), and accident injuries. These are being explored separately.

 

      Key Documents

Maternal and Child Mortality Development Goals - What Can the Transport Sector Do?
Julie Babinard, Peter Roberts, August 2006 (PDF 288KB) 

This paper focuses on the ways in which transport and road infrastructure play key roles in the overall delivery of and access to health services, and in the effectiveness of the health referral process.

Benefiting from Transport in Achieving the Better Health Outcomes (PDF 257 KB)
The World Bank presentation an Transport Forum, 2004
Comparative assessment of transport risks - How it can contribute to health impact assessment of transport policies (PDF, 474KB)
Tord Kjellstrom, Lorrae van Kerkhoff, Gabriele Bammer, & Tony McMichael
Bulletin of the World Health Organization 2003, 81 (6)
Transport, environment and health (PDF, 1287KB)
WHO Regional Publications, European Series No. 89, 2000
Transport for Health Care Delivery - Three provincial case studies (PDF, 177KB)
South African Health Review 2002 (8th edition); Publisher: Health Systems Trust

The World Health Report 2005: Make every mother and child count (PDF, 529KB) 

Who's got the power? Transforming health systems for women and children (PDF, 1857KB)
UN Millennium Project Task Force on Child Health and Maternal Health 2005, Earthscan
Urban Transport and the Millenium Development Goals (PDF, 108KB)
Article by Walter Hook, PhD, Executive Director, Institute for Transportation and Development Policy (ITDP)
Health sector in Ghana and roles for transport interventions (PDF, 537KB)
Institute for Transportation and Development Policy (ITDP), 2005
Health sector in Senegal and roles for non-motorized transport interventions (PDF, 537KB)
Institute for Transportation and Development Policy (ITDP), 2005
The MDGs for Health -- Rising to the challenges (PDF, 3278KB)
The World Bank, 2004
Rating maternal and neonatal health services in developing countries (PDF, 135KB)
Rudolfo A. Bulatao and John A. Ross
Bulletin  of the World Health Organization 2002, 80 (9)
Investing in Development: A Practical Plan to Achieve the Millennium Development Goals
Millennium Project (PDF, 3.6MB)

  

      Useful Links
UN Millennium Project
Maternal mortality: Africa's burden - Toolkit on Gender, transport and maternal mortality
Cornell University
Health and Mobility
The International Forum for Rural Transport and Development (IFRTD)




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