The Malawi Experience – Research
As part of Phase 1 of the Pedal Powered Hope Project (PPHP), a comprehensive research component was established to measure the change between having a bike and CareCar and not having access to a bike and CareCar. It was also a chance for BWB to better understand the beneficiaries, their work, and to learn more for future projects. There were three main research questions:
- What are the transportation needs of community health care workers, cyclists and pedestrians in Zomba?
- What is the situation like for Community Health Volunteers (CHV) and Volunteers in Zomba District with and without a bike and CareCar?
- What is the value of a bike and CareCar?
Three surveys were conducted. One survey was for CHV’s, one survey was for cyclists, and one survey for pedestrians. Ten Chancellor College graduates from the International Development program were hired as Enumerators/Researchers for the project. Enumerators were fluent in English and the local language Chichewa. The 3 surveys (CHV, cyclist, pedestrian) were translated into Chichewa and Enumerators were trained for 2 full days on comprehension and survey expectations. Surveys were piloted for 2 days with some revisions in order to help respondents better comprehend the questions dealing with time and currency which can be difficult to articulate amongst illiterate respondents.
Prior to surveying, permission was requested from each Village Head Person from the corresponding area that would be visited in Zomba District. Verbal and written permission was granted by each Village Head Person for the duration of the surveying project. Support and enthusiasm was evident with each discussion about BWB and our goal. Verbal and written permission was also granted from the District Health Officer who was excited to learn about our efforts to assist CHV’s and had requested a meeting to discuss the surveying results since his department was severely under-staffed and lacking resources to perform such tasks.
Through consultation with the National Statistics Office and the District Assembly’s Social Welfare Office, a comprehensive list of Community Based Organizations (CBO), Health Facilities, and detailed maps for Zomba District were compiled. A nonprofit organization, Invest in Knowledge Initiative (IKI) played an integral role in designing the methodology and reviewing the questionnaires. IKI partners with institutions to deliver research solutions while building local capacity. Their customized approach combines rigorous scientific methods with field research programs and classroom training. IKI strives to advance the knowledge and skills of their partners to address and answer key policy questions with scientific methods and evidence.
Each Health Facility and Hospital was visited prior to surveying to discuss the research component with the Health Workers. Health Facility professionals introduced us to at least 1 CHV in the catchment area. Appropriate dates were selected when CHV’s would usually meet at the health facility or CBO for meetings and we agreed to meet at the same time for surveying. Word was spread to every CBO and CHV in that particular catchment area. In each healthcare facility catchment area 1 local person was recommended by the Village Head Person was hired to visit CBO’s and CHV’s to confirm the date and time for surveying. CHV surveying would be performed at either the healthcare facility or CBO, and interest was overwhelming. Some CHV’s walked over 20km to have their voices heard. Focus groups were arranged for healthcare professional staff and CBO Chair People because they were considered key informants of the healthcare sector.
Cyclists and Pedestrians were surveyed at Trading Centres on the corresponding market day for that week. Cyclists and pedestrians were also surveyed using a random sampling method with every 4th household in surrounding villages selected.
Our transportation research component spoke to numerous respondents in Zomba District. They included: 309 Community Health Volunteers (49% had access to a bike and 51% did not have access to a bike), 210 cyclists, and 160 pedestrians.
According to our findings, it is evident that the bike increases efficiency for Community Health Volunteers. For example, CHV’s with bikes:
- Visited 13% more patients a day compared to those without bikes;
- Spent 46% less time travelling to deliver healthcare;
- Were spending 4.6 days a week providing healthcare, while those without bikes were spending 3.4 days a week providing healthcare; and
- Spent 26% more time per week providing their services.
When looking at urgent needs patients CHVs with bikes have 45.6 patients a week who need urgent care but do not get transport to a Health Centre, while CHVs without bikes have 45.5 patients a week who need urgent care but do not get transport to a Health Centre. The difference in need is negligible at 0.1 patients per week. Therefore, all CHV’s have about the same amount of patients in need.
When emergencies arose and patients were transported to a healthcare facility by CHV’s the most commonly used method (48.4% of the time) was using makeshift stretcher or carried by hand. This was life saving about 69.5% of the time. The second most commonly used form of transport for urgent needs patients to get a healthcare facility was by sitting on the rear of a bicycle (34% of the time). This was life saving about 82% of the time but was extremely difficult when the patient was in serious condition and could not lie down. The third most commonly used form of emergency transport was the bicycle ambulance or CareCar, which was used about 9% of the time. It proved to be life saving 89% of the time. It is greatly dependent on what resources the CHV’s have access to.
Those with access to the bicycle ambulance almost always used it for emergency purposes where those without a bicycle ambulance associated to their CBO or in their village would not have this as an option. All the respondents agreed that a CareCar would be very useful or is very useful to them.
According to all the respondents surveyed, those with bikes travelled 11.6 km on their most common daily trip, while respondents without bikes travelled 7.5 km on their most common daily trip. The difference in the number of kilometers is 4.1 km, or approximately 36% more kilometers for those with bikes. All respondents with bikes had a monthly income of 11,409.09 MWK ($73.60 CDN) while respondents without bikes had a monthly income of 6,350.30 ($40.97 CDN). The difference in monthly income is 5,058.79 MWK ($32.64 CDN) or about 44% higher for those with bikes.
In addition, respondents with bikes were more engaged in the business sector and more likely to be selling more goods on market days. Each day of the week there is a different market day at a particular trading centre in the District, therefore some are closer than others, cyclists would have access to the farther markets therefore selling more goods and increasing their income. All respondents with bikes spend on average 301-350 MWK ($1.94 – 2.26 CDN) on transportation each week. All respondents without bikes spend on average 351 – 400 MWK ($2.26 – 2.58 CDN) on transportation each week. The difference in amount spent on transportation each week is 50-100 MWK (.32 – 0.64 CDN) or about 17-33% lower for those with bikes.
It was stated that those with bikes generally always used their bike for transportation except when the bike was lent to someone to borrow and therefore their reason to pay for transportation. Those without bikes could not afford to pay more for transportation due to their level of income and therefore relied primarily on walking. Those without bikes were less likely to visit markets, and less likely to be involved in the business sector.
According to all respondents, they were willing to pay 10,100 MWK ($65.16 CDN) or about four times their monthly salary to own a bicycle. Respondents with a bike stated that their most prized possession was their bike and it is clear that it is highly valued amongst all respondents. Every CHV stated that the CareCar or bicycle ambulance was a very useful form of transportation for urgent needs patients and was also highly valued amongst every respondent.