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Introduction

1.1 The importance of transport

The implementation of effective and comprehensive health programmes in a district is dependent on the availability of adequate transport. Transport, especially in rural areas, is critical for:

• Mobile health services to people living in rural and remote areas, without access to a fixed clinic.
• Transporting patients to a referral facility (e.g. from clinic to hospital, or from district hospital to regional hospital).
• Providing clinics with their drug and equipment supplies.
• Community-outreach services (e.g. supporting community-based nutrition projects, community- based DOTS, etc.).
• Supervision and support visits to clinics by clinic supervisors, doctors, etc.
• Non-facility based public health services such as environmental health.
• Meetings with other role-players and stakeholders such as community structures, other public sector departments and NGOs.
• School health and occupational health visits.
• Attending meetings and workshops.

1.2 Background and Purpose of the Mount Frere study

In the Mount Frere Health District, the District Management Team (DMT) has made considerable improvements in the control and monitoring of vehicles. However, despite this, there is a common cry from programme managers, clinic supervisors, doctors and administrative staff that there is a shortage of transport for them to carry out their functions adequately.

Because transport is so critical to so many functions, it is not surprising that there is a relative lack of transport, compared to needs. It is therefore important that districts make sure that they use their limited transport resources efficiently and effectivel y

In Mount Frere, management personnel were frequently expected to attend meetings and workshops, often at short notice, outside the district. Somehow, transport was always made available for these trips, even at the expense of other health-care related trips, such as to a clinic or to the community. It was therefore questioned whether transport was more often used for administrative and bureaucratic purposes, rather than for supporting service delivery.

In view of the above, a rapid study of the use of transport in the Mount Frere district was conducted with the assistance of ISDS. The purposes of this study were to:

1. Determine the purpose of each trip made by the district pool of vehicles 1 for the period March to May 1999.
2. Rationalise and improve the use of vehicles in the district.
3. Assess the degree to which demands from the regional and provincial offices are made on district transport, especially for functions that are not directly related to patient care.
4. Assess the effect of delayed authorisation for repairs to vehicles on service delivery.

1.3 Who will benefit from reading this document?

This document is aimed primarily at District Health Management Teams, to encourage them to analyse and study how they are utilising their transport resources.

It is also aimed at regional and provincial level health managers who often make frequent demands on the use of transport, sometimes to the disadvantage of front-line health workers and the local community.