Benefiting from Transport Presentation to the Transport Forum Elizabeth Lule Advisor, HDNHE January 15, 2004

Poor prospects for MDGs unless synergies are exploited

I. Transport is a key input in achieving health outcomes

Why is transport critical? Improves utilization by improving access to health facilities. In rural Tanzania, 84 percent of women who gave birth at home intended to deliver at a health facility but did not due to distance and lack of transportation (Bicego et al., 1997) Facilitates mobile services to hard to reach areas Essential for distribution of drugs, blood and other supplies to health facilities Necessary for an effective referral system between different levels of the health system Facilitates monitoring and supervision

Lack of transport kills mothers and children Obstetric emergencies are difficult to predict, when they occur during a home delivery, getting the mother to a hospital is critical. Distance, poor roads and lack of ambulances and other means of transport delays the management of life threatening complications Because complications cannot be anticipated e.g hemorrhage which is fatal within 4 hours – it is often difficult to plan ahead the resources to pay for transport and availability Poor families are worst affected because transport is often unaffordable.

The Power of Intersectoral Partnerships

Unsafe Road Transport contributes to Global Burden of Disease An estimated 1.17 million deaths occur each year worldwide due to road accidents. The majority of these deaths, about 70 percent, occur in developing countries. Sixty-five percent of deaths involve pedestrians and 35 percent of pedestrian deaths are children. Over 10 million people are crippled or injured each year. Road crushes are the second leading cause of death for people aged 5-29 Low and middle income countries experience 85% of the deaths and contribute to 90 percent of the disability adjusted life years lost to road traffic injuries and deaths The road traffic epidemic will grow exponentially and by 2020 will likely be the third leading cause of DALYs lost ( India (147% increase) and China (92%) worst affected) Has implications for health systems

The Evidence Base is Weak Improved rural roads is associated with substantial increase in health care access (Morocco, Tanzania, Malaysia) 11.5% of Africans report that the unavailability and cost of transport is a major barrier to obtaining health care Better roads allows for establishing health centers, retention of health providers Availability of transport and communications (two way radios) contributed to increased access to skilled care ( Uganda Rescuer project)

What are the implications for the Bank How do we improve intersectoral collaboration within the Bank and at the country level an in operations? How do we strengthen the evidence base to facilitate cross sectoral policy dialogue? How do we coordinate intesectoral analytical work to better understand cross sectoral synergies and learn from each other How do improve cross sectoral linkages within the Bank instruments CASs, PRSPs etc? How do we monitor and evaluate progress? What are the relevant partnerships?