'No Ambulance, No Worries':
Bicycles Fill Patient Evacuation Gap in Rural Uganda
Written by: Rhonet Atwiine. Documentary by Dan Ayebare. Film and Photography by Jeremiah Mukiibi
Thursday, January 30, 2025
Halima Musubika is seven months into term. Unlike other pregnant women in Uganda’s remote communities who worry about emergency evacuation, she is content that her’s will be manageable.
Musubiika’s home in Buwala village is situated about seven kilometers from Lumuli Health Center II, a relatively well-equipped public health facility serving a radius of more than five kilometers in Buwenge Sub County, Jinja district.
It costs about 5,000 UGX (just over a dollar) by motorcycle taxi, which she sometimes can not afford all the time.
“I am confident that when I am due, I will call our bicycle ambulance since I don’t have the money to hire a vehicle or boda boda,” Musubika shares.
Yes, you read that correctly. Pregnant women in Jinja district and other communities in Busoga subregion are relying on bicycles to fill the medical emergency response gap
A village health team member supports a child in the bicycle ambulance. Photo by Jeremiah Mukiibi.
The bicycles are a concept of First Africa Bicycle Information Organization (Fabio) which uses bicycles to challenge communities to meet their collective needs.
The charity works with the Village Health Teams, who are the fast health responders in Uganda’s health structure. They are trained in emergency cycling and supplied with the ambulances.
The bicycles operate on assisted pedaling from a pre-charged battery, which makes it easy for the rider to navigate hilly terrains.
Attached to it is a fabricated bed trailer where a patient rests during evacuation.
Brian Nkuutu, the Programs Officer at Fabio explains that the bicycle’s pedal-assist system allows it to reach up to 30 kilometers per hour.
This means an expectant mother could reach the health center in just 12 minutes, a huge improvement over a standard bicycle.
“This particular bike operates on a pedal-assisted system which helps the bike to move about 30 kilometers per hour,” he says.
A patient being delivered at Lumuli Health Center II. Photo by Jeremiah Mukiibi
In Uganda, emergency-related conditions account for more than half of the maternal and infant deaths.
According to public health experts, maternal health emergencies, the speed and quality of emergency medical services play a crucial role in determining patient outcomes.
However, a 2023 report by Twaweza, a non-profit organization monitoring public service delivery in Uganda, reveals that many citizens are more likely to visit health centers or seek help from their communities simply because they are unaware of alternative options.
The report further shows that only 1 in 20 Ugandans knows about a toll-free emergency services number, and less than half of those can identify the correct number. Additionally, just 2 in 10 are aware of any ambulances that can be called in their area.
Nationally, ambulance utilization averages only 7.5%, with the Busoga region reporting one of the lowest rates at just 4.7%.
Tonny Mutiibwa, the Senior Health Educator for Jinja, highlights that the district faces malaria challenges, accounting for 30% of out-patient cases, particularly affecting expectant mothers.
Given the rising malaria cases, there is an urgent need for quick access to quality emergency services. However, a shortage of ambulances hinders this urgency.
“We only have two ambulances. One is allocated to the region but managed by the district local government, while the other serves the entire Busoga region. This limited capacity means that ambulances can’t cover all areas, leaving a gap in emergency services. Therefore, we depend heavily on bicycle ambulances to fill this gap,” Mutiibwa explains.
Challenges in ensuring emergency patients reach health facilities by ambulance highlight critical gaps, including limited resources to purchase ambulances, insufficient fuel, a shortage of trained staff, and a lack of public awareness about emergency services.
In Musubika’s community, mothers used to rely on traditional birth attendants (TBAs) because of the distance, rising the maternal mortality level at least according to her midwife, Constance Nampiima.
TBAs are mostly older women who provide health care and advice to pregnant women, during labor, and for new babies. They pose significant birth-related risks, particularly for mothers with pregnancy complications, which can sometimes lead to fatalities.
In the community, they have been responsible for dozens of maternal and infant deaths.
Nampiima says she handles about five mothers on average per week, and all thanks to the ambulance that is easing their movements.
“When that time comes, you find that mothers are unable to come to the facility and end up delivering with TBA’s. But the bicycle and the VHT model has helped to support their movement to the health facility and reduce the maternal death risk,” Nampiima says.
“I always create an antenatal care plan for every pregnant mother, but only a few adhere to regular visits. When I ask why, they often say they lack the money or can’t manage to travel over 6 miles every week. As a result, some miss essential injections, and we are forced to handle emergencies that could have been prevented,” Nampiima notes.
Village Health Team member Moses Kalera rides a patient to hospital. Photo by Jeremiah Mukiibi.
In Uganda, locals are now relying on community-based initiatives to bridge the gap. Mutiibwa highlights that motorcycles and bicycles are being promoted as alternative means of transport due to their availability and ability to cover long distances.
These models have contributed to reducing the maternal mortality ratio from 336 per 100,000 live births to 189 per 100,000 live births.
According to Mutiibwa, the initiative has also lowered the district’s healthcare budget, reduced infant mortality rates, and enhanced the overall well-being of the community.
Bicycle ambulances are used not only for expectant mothers but also for other patients. For example, Musubika used one to transport her child to a health facility for a severe toothache.
Health Responders in this community have transported about 100 patients to different facilities in the last two years, according to Fabio.
The model has been spread across the Busoga subregion in underserved communities of Jinja, Mayuge, Iganga, and Kamuli.
Despite the visible impact, embracing the bicycle ambulance has come with reservations for some of these communities.
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