Build it and they will come? Yes, with creativity, evidence, and cross-sector coordination.

Photo By: PATH

In many remote regions around the world, it is extremely difficult for women in labor to reach a hospital or a clinic, causing risks to their lives and the lives of their babies. The important role mobility plays in health in the developing world is well documented. In India, the convening of key stakeholders across many government sectors was critical to galvanize a statewide, lifesaving ambulance service. 

In the Indian state of Uttar Pradesh (UP), the lack of transportation options for women to reach hospitals resulted in high rates of maternal and infant mortality. The state government identified the problem in 2011 and publicly committed to building a stronger transportation service through the purchase of 2,000 ambulances.

PATH, a long-time implementer of maternal and newborn health programs in UP, supported the government’s initiative to build a transport service. But, how would women access the ambulances? What care would be provided en route? And how would facilities need to be equipped to receive the ambulances? Health advocates in the region recognized that a comprehensive plan that addressed issues beyond transportation would be necessary to successfully deploy the ambulances.

This was particularly challenging as health and infrastructure sectors within the UP government were not well aligned and evidence surrounding the field of emergency transportation was limited. My PATH colleagues assembled an array of partners, including the National Rural Health Mission for the state of UP, the National Health System Resource Center, and UNICEF’s local representatives, to help our friends in the Government of Uttar Pradesh (GoUP) develop an official policy framework, informed by considerations that went beyond transportation, and with support from experts in various fields.

Over a two-year period with our partners, health advocates pulled together evidence in support of the project while building relationships with key national and regional officials across Indian states. Our key stakeholders saw that a coordinated effort in UP was possible when they were able to visit a leading emergency transportation system first-hand in another Indian state. We sustained momentum for the project by having a wide array of champions at all levels across India.

Creativity helped us overcome bureaucracy and changes in leadership. Instead of focusing on one policy directive – which would be easy to strike down – partners aimed to influence a series of key documents, each of which would play an important role in establishing a high-quality transportation program.

In 2013, officials issued a government order that paved the way for an emergency transportation system in UP. In the following year, 2014, when the official roadmap for the project was formally endorsed by the GoUP, the 102 Ambulance Service was established, becoming the largest public-sector ambulance service in the world.

Today, as a result of this service, any woman in UP can dial a toll-free 102 number and expect an ambulance within 20 to 30 minutes. All ambulances provide basic life- support emergency services and are staffed by a skilled attendant. The end result of this new coordinated ambulance transportation service? Fewer women and children in Uttar Pradesh are unnecessarily dying because they can’t reach skilled care. That is something the GoUP, health advocates, and citizens can all be proud of.

The development of a policy to support and sustain a large fleet of ambulances in Uttar Pradesh is a model of success for health advocacy in the developing world. To learn more about PATH’s work in health policy and our 10-part evidence-based strategy for advocacy impact visit PATH's Advocacy Impact page.

By Tarun Vij, PATH’s country program leader in India. He oversees the strategic, programmatic, and financial operations for a matrix of global and in-country programs implemented across PATH’s five offices in India. He also represents PATH to state governments, policymakers, the global health community, donors, and media.