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  • Title: Alternative forms of transport and their use in the health services of developing countries.
    Author: Gish O, Walker G.
    Journal: Int J Health Serv; 1978; 8(4):633-51. PubMed ID: 730411.
    Abstract:
    During the past few years greater interest has been shown in ways in which the coverage of health services in developing countries might be increased. Frequently, it has been advocated that greater use be made of mobile health services, often using relatively sophisticated transport systems, including aircraft. The present article examines the uses to which mobility in health services has been put and the merits of different forms of transport, within the resource constraints and health "needs" of Third World countries. Our main conclusions are that for the majority of health service movement appropriate intermediate technology transport should be used (i.e. bicycle, animals, or motorcycles). The use of mechanical transport within health services with the highest benefit per unit cost is likely to be that employed in the regular supportive (not policing) visits to permanently staffed fixed basic care facilities by more highly skilled and scarce health personnel. Those clinics located closer to the regional base can usually be reached more cheaply by land transport, while those at a distance might justify the use of a light aircraft. Where aircraft are used in this supportive role, it is important they are integrated into the ongoing health services and tightly scheduled to lessen the risk of their diversion to less cost-effective activities. Interest in mobile health units for developing countries has led to the advocacy of sophisticated transport systems including air transport. However, the medical needs of Third World countries do not usually indicate air transport as a cost efficient delivery method. Flying health services are justified in conjunction with fixed health facilities and regular visiting of farflung stations. Land vehicles, cars, and trucks, should be used for support supervision for lower-level institutions and care of selected screened patients. The high cost of fuel and maintenance prohibits any but the most necessary transportation. Land vehicles are more desirable than airplanes because the medical personnel are more likely to see more people en route and remain longer in an outpost once they have arrived. Too often health services must be rushed to accomodate flying conditions and taking off before dark. More attention should be given to appropriate low-technology transport like bicycles, animals, or motorcycles.
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