Celebrate Solutions: Leveraging the ‘Foot Ambulance’ in Filipino Villages

By: Rati Bishnoi, Special Projects Intern at Women Deliver

For generations, men in the villages nestled in the remote mountains of the Ifugao province in the northern Philippines have used the “ayod” or hammock to carry the sick to hospitals and medical facilities.

Now, this traditional “foot ambulance” is increasingly becoming the heart of a community-grown maternal health system that is saving the lives of women and girls and keeping families and communities intact in this rural area.

Ifugao’s maternal mortality ratio of 260 deaths per 100,000 live births towers over the national maternal mortality ratio of 162 deaths per 100,000 live births in part because only 30 percent of women in the area give birth in hospitals or medical facilities. With a majority of women delivering without the assistance of proper medical help, avoidable obstetric emergencies are often mismanaged and lead to death.

Across the last three years, however, provincial, municipal, and village health officials have elevated the ayod from a way to transport the sick to the hub of maternal health care for communities. In 2008, Philippine health officials—based on earlier work under the model by the Japan International Cooperation Agency and UNFPA—established the Ayod Community Health Teams (ACHTs). In addition to transporting patients, these teams are in charge of keeping a record of all pregnant women in the village, monitoring and tracking their health, assisting couples with preparing birth plans, encouraging women to deliver in health care facilities, and reminding them to get nationally mandated pre-natal exams.  Lastly, the teams also gather information on and report maternal deaths and the deaths of all children under the age of five to the Municipal Health Office.

“The ayod has always been there, but now, institutionalized as a community effort, it has mitigated the two factors that greatly affect maternal health, namely: the decision to seek care and the means of transportation to get it,” according to Hector Follosco, a UNFPA provincial programme officer.

Traditionally two men carry the ayods and are accompanied by two men or women, who provide the patient water and food along the journey. In ACHTs, the involvement of men “signifies a paradigm shift” in the village, as it shows the whole community that men too are responsible for the range of health care—including maternal and reproductive health care—of their family and community. Teams include the village leader, rural health midwife, health workers, nutrition scholars, two women and men volunteers, and traditional birth attendants.

Despite the expanded services provided by the ACHTs, some mothers were still hesitant to give birth at medical facilities because they were unsure of the care they would receive, says Provincial Health Officer Mary Josephine Dulawan. To minimize these concerns, the ACHTs launched community awareness campaigns to educate pregnant women and their families about the realities and benefits of giving birth in facilities.

As a result, health officials note that an increasing number of women are embracing giving birth in medical facilities. Most importantly, ACHTs are leading to saved lives. The Ifugao government, which now manages 185 ACHTs and 2,865 members, claims to have had no maternal deaths and only two neonatal deaths between 2006 and 2010 in nine villages using the new system.