Simple mobility solutions at the village level can save many lives. In the scorching heat, struggling with an ice box with children’s vaccines in one hand, bulky registers in the other and a big purse with her daily requisites, Meena, an auxiliary nurse midwife (ANM) from Banda village in Rajasthan, is waiting for the public bus. If she misses the bus, which comes every four hours, lives would be at stake. It is the Village Health and Nutrition Day (VHND) and people—women with newborn babies, pregnant women, the old and the infirm—would be queuing up for vaccination and medical treatment. The only other option for her is to either ask a family member for a ride or walk 5km through muddy and broken pathways.

ANMs like Meena face such situations daily. The ANM is a village-level health worker, who is the first point of contact between the community and the health services. She is usually deputed at one health sub-centre, which caters typically to four villages and a population of 5,000. Due to the shortage of staff or transfers, sometimes, a single ANM may be responsible for more than one sub-centre. The average distance between two villages catered to by a sub-centre may vary between 2km and 10km. Not all people are able to visit the sub-centre, especially during medical emergencies. The 108 emergency helpline informs the ambulance services about such cases. However, timely information alone is not sufficient. Time is lost in getting to the village on the VHND, and in reaching the patient in an emergency even before the ambulance gets there. If the ANM is in a village providing services on the VHND, and someone suffers a heart attack in another village 10km away, she can rush to the spot to provide immediate medical attention. But how will she get there? There is no direct bus between the two villages and taking a lift from a stranger is not feasible due to safety issues. The only option is to navigate the entire distance walking down the kutcha road, juggling the entire load of medicines, bag and registers.

It may seem like a bleak picture with an improbable solution. But sometimes, complex public health problems have simple solutions—solutions in dire need of philanthropic attention. Providing a mobility solution in the form of a two-wheeler to the ANM is a probable answer. In Rajasthan, we tested a limited number of two-wheelers for ANMs. They were selected based on the number of villages an ANM is responsible for, distance between her sub-centre and various villages that fall within the sub-centre and her driving skills.

The impact of this simple intervention was enormous—ANMs were able to attend to emergency situations in villages without being worried about transport. Service delivery became better as ANMs could provide healthcare services with undivided attention. The number of trips as well as the time spent per trip increased significantly. This solution is not bereft of challenges. Transfer of ANMs can lead to confusion on the ownership of these vehicles. A possible solution is that a sub-centre can be the owner of these vehicles and in turn the ANM working there its custodian. A need to devise a monitoring system to keep a check if the vehicle was used for its designated purpose was also felt. We tried GPS with mixed results and many operational problems.

In India, the idea is still at a fledgling stage. The Telangana government recently launched Project Rekkalu in which select ANMs are provided with two-wheelers to facilitate their commute to the villages. The Tamil Nadu government trained village health nurses and ANMs to ride two-wheelers.

Donors want to see measured impact before investing in any intervention, and a mobility solution offers this. However, intangible outcomes, which have an indelible impact on the service provider, are evident. In the words of Meena, as she proudly showed us her shining new vehicle, “Knowing that I just need to switch on my two-wheeler and rush when I am needed is truly empowering."

Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok.

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