*Y.C.* Mums & Kombis
More than half of South Africans today rely on minibus taxis, or kombis, as their main mode of transportation (Walters, 2008). The kombi industry continues to grow and now, more than ever, with the 2010 World Cup right around the corner, the South African government struggles to formalize this sector. Access to and means to pay for transportation remain a large barrier in the provision of maternal healthcare worldwide and South Africa is no exception. One recent study found that transport was the number one obstacle to receiving adequate and appropriate maternal healthcare (Tlebere, et.al, 2007). As a result, my idea brings together and addresses two areas of concern for South Africa at this time - maternal health and transportation. I propose to first pilot the program in the municipality of eThekwini, Durban focusing on the difficult to reach townships that surround the city.
My idea has two major arms which support one another. The first arm addresses the delay in reaching the maternal healthcare facility (Barnes-Josiah, et.al., 1998), i.e. not having the money and/or transport that will take the woman to the appropriate provider. In attempts to decrease the number of minibus taxi-related fatalities due to faulty vehicles, the South African government offers new minibus taxis, some even equipped with DVD players for passenger viewing, in exchange for older models at low-to-no cost. As many kombi 'bosses' are taking advantage of this scheme, I propose that taxi bosses are offered a reduction in taxes paid on their kombi businesses in exchange for nighttime (7pm - 5am) on-call free emergency transport services and emergency cell phone (given to on-call driver each night). Kombi bosses will also agree to transport mothers in emergency situations free of charge during the day time. As transport during the day is easier for individuals due to the frequency of kombis that shuttle individuals from rural areas to more urban surroundings, it is during the night that access to transport is more difficult leading to further delays in seeking healthcare.
Amongst themselves, minibus taxi associations are very well organized. One group will cover certain grounds, leaving another association to cover other areas. As a result, it will be essential to have access to this information to determine that all communities in the municipality do indeed have access to transportation. Additionally, one community-health worker (CHW) in each township will be the sole communicator to request transport during the night hours, i.e. the CHW will be the only individual that possesses the emergency phone number in order not to abuse the system. The CHW will be trained in recognizing the dangerous pregnancy/labor signs and symptoms and will determine if the emergency phone number will be called. Additionally, the CHW will make the same judgment for day-hours emergency situations and contact the bosses to inform them that the women will travel free of charge. There is wide cellphone coverage in Durban, including in the townships, and therefore one does not foresee a problem with access to the emergency phone number.
The second arm of this idea puts a spin on social marketing campaigns. The campaign on maternal health education in Durban will include brightly-designed minibus taxis displaying slogans on the importance of pregnant women to get tested for HIV/AIDS, for example; and multimedia inside the kombis playing mini-dramas and advertisements focused around how, when, where to seek local maternal healthcare. This will not only allow the general public to be educated about maternal health but also allow local artists to develop using the komkis as a medium to display their art. Local artists will be asked to volunteer their time to display their artwork on these omnipresent vehicles. Additionally local actresses and actors will be asked to film short dramas on maternal health education and local resources which will be played in all kombis either through DVDs or radio. As social marketing campaigns already exist in South Africa on the prevention of HIV and prevention of mother-to-child transmission of HIV/AIDS, this work can be transferred to be displyed on and in the kombis.
Barnes-Josiah D, Myntti C, Augustin A (1998). The "three delays" as a framework for examining maternal mortality in Haiti. Social Science & Medicine, 46(8):981-93
Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, Wigton A, Treger L and Chopra M (2007). Community-Based Situation Analysis of Maternal and Neonatal Care in South Africa to Explore Factors that Impact Utilization of Maternal Health Services, Journal of Midwifery & Women's Health 52(4), 342-350
Walters, J. (2008) Overview of public transport policy developments in South Africa, Research in Transportation Economics, 22(1), 98-108
About You
Section 1: About You
First Name
Amy
Last Name
Goh
Website
Organization
Country
United States, DC
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
Yes
Section 2: About Your Organization
Organization Name
Organization Website
Organization Phone
Organization Address
Organization Country
The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..
Your idea
Name Your Project
*Y.C.* Mums & Kombis
Country your work focuses on
South Africa, KN
Describe Your Idea
More than half of South Africans today rely on minibus taxis, or kombis, as their main mode of transportation (Walters, 2008). The kombi industry continues to grow and now, more than ever, with the 2010 World Cup right around the corner, the South African government struggles to formalize this sector. Access to and means to pay for transportation remain a large barrier in the provision of maternal healthcare worldwide and South Africa is no exception. One recent study found that transport was the number one obstacle to receiving adequate and appropriate maternal healthcare (Tlebere, et.al, 2007). As a result, my idea brings together and addresses two areas of concern for South Africa at this time - maternal health and transportation. I propose to first pilot the program in the municipality of eThekwini, Durban focusing on the difficult to reach townships that surround the city.
My idea has two major arms which support one another. The first arm addresses the delay in reaching the maternal healthcare facility (Barnes-Josiah, et.al., 1998), i.e. not having the money and/or transport that will take the woman to the appropriate provider. In attempts to decrease the number of minibus taxi-related fatalities due to faulty vehicles, the South African government offers new minibus taxis, some even equipped with DVD players for passenger viewing, in exchange for older models at low-to-no cost. As many kombi 'bosses' are taking advantage of this scheme, I propose that taxi bosses are offered a reduction in taxes paid on their kombi businesses in exchange for nighttime (7pm - 5am) on-call free emergency transport services and emergency cell phone (given to on-call driver each night). Kombi bosses will also agree to transport mothers in emergency situations free of charge during the day time. As transport during the day is easier for individuals due to the frequency of kombis that shuttle individuals from rural areas to more urban surroundings, it is during the night that access to transport is more difficult leading to further delays in seeking healthcare.
Amongst themselves, minibus taxi associations are very well organized. One group will cover certain grounds, leaving another association to cover other areas. As a result, it will be essential to have access to this information to determine that all communities in the municipality do indeed have access to transportation. Additionally, one community-health worker (CHW) in each township will be the sole communicator to request transport during the night hours, i.e. the CHW will be the only individual that possesses the emergency phone number in order not to abuse the system. The CHW will be trained in recognizing the dangerous pregnancy/labor signs and symptoms and will determine if the emergency phone number will be called. Additionally, the CHW will make the same judgment for day-hours emergency situations and contact the bosses to inform them that the women will travel free of charge. There is wide cellphone coverage in Durban, including in the townships, and therefore one does not foresee a problem with access to the emergency phone number.
The second arm of this idea puts a spin on social marketing campaigns. The campaign on maternal health education in Durban will include brightly-designed minibus taxis displaying slogans on the importance of pregnant women to get tested for HIV/AIDS, for example; and multimedia inside the kombis playing mini-dramas and advertisements focused around how, when, where to seek local maternal healthcare. This will not only allow the general public to be educated about maternal health but also allow local artists to develop using the komkis as a medium to display their art. Local artists will be asked to volunteer their time to display their artwork on these omnipresent vehicles. Additionally local actresses and actors will be asked to film short dramas on maternal health education and local resources which will be played in all kombis either through DVDs or radio. As social marketing campaigns already exist in South Africa on the prevention of HIV and prevention of mother-to-child transmission of HIV/AIDS, this work can be transferred to be displyed on and in the kombis.
Barnes-Josiah D, Myntti C, Augustin A (1998). The "three delays" as a framework for examining maternal mortality in Haiti. Social Science & Medicine, 46(8):981-93
Tlebere P, Jackson D, Loveday M, Matizirofa L, Mbombo N, Doherty T, Wigton A, Treger L and Chopra M (2007). Community-Based Situation Analysis of Maternal and Neonatal Care in South Africa to Explore Factors that Impact Utilization of Maternal Health Services, Journal of Midwifery & Women's Health 52(4), 342-350
Walters, J. (2008) Overview of public transport policy developments in South Africa, Research in Transportation Economics, 22(1), 98-108
Website URL
Innovation
What makes your idea unique?
The idea harnesses the newly-acquired power of the kombi industry. It not only uses the actual vehicle as a means to educate both insiders and outsiders but also the kombi industry itself can eliminate one of the main barriers in care for women to access care.
Do you have a patent for this idea?
No
Impact
This Entry is about (Issues)
What impact have you had?
Have not started the program.
Problem
As working 'on-call' is difficult for any profession, I foresee this as a potential problems for drivers. However, bosses may use the incentive of 'loaning' the taxis to the drivers overnight in order to utilize at the drivers expense to increase their income, as long as it does not interfere with providing transport for emergencies.
Additionally, as not all minibus taxi associations will participate, all areas may not be covered leading to continued poor access to care for some populations.
Actions
Have not started the program
Results
Increased education on the part of mothers and the general public around where to access maternal health.
Increased knowledge on maternal health, eg. danger signs and symptoms during labor.
Increased number of HIV testing for pregnant women and appropriate treatment if HIV+.
Decreased maternal deaths due to better transport access to care.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
Year One
Solid relationships formed between the government and kombi bosses.
Communities will be mapped in order to determine which areas will be covered and which areas may not be covered.
Agreements must be mutually agreed upon and signed.
Closely follow the program to address problems as soon as they occur.
Create a monitoring system examining statistics on frequency of use of taxis, reasons for usage, maternal deaths, HIV testing and treatment.
Develop an effective evaluation program.
Continue to re-evaluate funding and address funding needs by working with the government to continue to advocate for maternal health support.
To make the program self-sustaining, train appropriate in-country staff (including community health workers, taxi bosses and drivers) to take ownership of the program.
Year Two
Continual monitoring and evaluation.
Periodic trainings for staff to continue to stay educated and up-to-date and motivated.
Re-visit incentives for kombi drivers, make appropriate adjustments.
Recruit fresh artists to further expand/create murals on kombis and video/radio dramas.
Year Three
Continual monitoring and evaluation.
Transition fully to in-country staff.
What would prevent your project from being a success?
Lack of support from the government to specifically support maternal health needs.
Lack of dedication from the taxi bosses and drivers to provide the emergency transport when available.
How many people will your project serve annually?
1001‐10,000
What is the average monthly household income in your target community, in US Dollars?
$100 ‐ 1000
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Idea phase
Is your organization a
Please select
Is your initiative connected to an established organization?
No
If yes, provide organization name.
How long has this organization been operating?
Please select
Does your organization have a Board of Directors or an Advisory Board?
Does your organization have a non-monetary partnerships with NGOs?
Does your organization have a non-monetary partnerships with businesses?
Does your organization have a non-monetary partnerships with government?
Please tell us more about how these partnerships are critical to the success of your innovation.
There must be a strong relationship between the kombi bosses/drivers and the municipal department of transport.
The community health workers are also essential to this program as they will need to be trained and kept motivated.
What are the three most important actions needed to grow your initiative or organization?
Strong local support of improving maternal health from kombi bosses and municipal government.
Training of local staff to ensure the sustainability of the program, one of the most important are the community health workers.
Consistent and accurate monitoring and evaluation in order to address problems and make changes efficiently and effectively. This will also provide for support in spreading the initiative to other municipalities.
The Story
What was the defining moment that you led to this innovation?
For a research project, I interviewed partners of South African minibus taxi drivers and some of the drivers themselves. It quickly became clear to me that the kombi drivers held much power in many of these personal relationships and within their communities. I also became fascinated with the outer designs of the minibus taxis, each one possessing its own personality and style.
Tell us about the social innovator behind this idea.
A nurse who not only believes in the power of quality clinical care but also in the fulfillment of human rights, including social, culture and political rights.
How did you first hear about Changemakers?
Friend or family member
If through another, please provide the name of the organization or company
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Comments
This is a wonderful idea. It offers practical solutions not only to the transportation issues that pregnant mothers face, but also aims to address other key issues in the South African context. These include an incentive for taxi operators to become part of formalized economic structures within South Africa via the tax benifits. Formalization of the taxi transportaion industry is a key objective both at provincial and at national level in the country, so this idea fits in perfectly with these objectives.
How do you plan on convincing the government and the kombi industry to buy into this program? It sounds like it will be terribly difficult to implement since you have to get both organizations to back you. You also have to get willing people to volunteer to call in the kombis, get the kombi industry to let you put advertising on their buses, and organize routes for drivers to take. I think your idea sounds amazing but how do you plan to implement it?
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