Rural Transport and Health - Can we change the environment in a moment?
by Naboth Juma Okoth

In Africa especially the East and Southern part, the impact of various diseases like malaria, EBOLA, typhoid, and HIV/AIDS are evident in many sectors including transportation. The need for a multi-sectoral approach to mitigate the spread and impact of such diseases especially HIV/AIDS and EBOLA, is universally acknowledged.

As the writer of this article I am not a researcher but serve in the bicycle transport system in Kisumu, Kenya, as a transport operator and have been in the industry for the last sixteen years.

The transport sector is recognised as a catalyst of health problems, but it also offers a network of solutions. In this article I will identify two key problem areas and then offer some solutions. The two problem areas include:

- The bringing together of workers in temporary camps, in parking bays for bicycle transporters and at lake shows for the waterways. Bicycle operators, especially those working at night, ferry prostitutes and parking ladies from one pub to another and lastly to their houses. This is an environment where the absence of normal social networks to regulate behavior encourages sexual activity between non-regular partners. So communities living alongside and even the transport operators’ partners represent a legitimate focus for transport sector strategies to mitigate the spread and impact of such diseases.

- Areas of transport activity such as transport corridors, stopping places and terminal points that demonstrate increased level of promiscuous sexual contact and spoilt air for air-borne diseases.

Generally the higher prevalence of diseases such as EBOLA and HIV/AIDS among transport operators is an indication of the increased risk that the partners of transport operators and communities living in areas of intense transport activity are exposed to. Despite the general recognition that a highly mobile population falls into a high risk category for EBOLA and HIV/AIDS there is no explicit acknowledgement within transport policies of the need to safeguard the partners of transport operators and those living around areas of transport activity or using these means of transport during night hours.

In most cases only the long distance drivers have been targeted by programs that neglect non-motorised operators, partners, communities living alongside busy corridors and hubs. Many of these programmes are initiated and carried out externally for long distance drivers and do not engage with communities or the non-motorised transport sector. It is erroneous to treat one person for sexually transmitted diseases while leaving the counterpart aside even though there is education campaign and condom distribution, these are not always a panacea for unsafe sexual behavior. These kind of programmes are usually designed with only the operators in mind but do not speak to the poor, parking ladies, commercial sex workers, and isolated communities situated in areas of intense transport activity who also have a strong incentives to engage in unsafe sexual activities for monetary reward or status symbolism.

Nguare Bicycle Transporters Youth Group, with support from AMREF in collaboration with CIDA, have been unravelling the socio-economic costs, including health care, home based care, transport to clinics and hospitals, to those found positive.  Also the impact on social networks, for example increases in child labor, bicycle operators exploitation, prostitution and sexual abuse among the operators.

Solutions

Now that we have identified the gaps, these interventions could be used to address the existing challenges: Properly designed policies addressing the operators, their partners, community around the terminals and hubs parking ladies and commercial sex workers.

- Carry out programs with an overall objective of increasing access to HIV/AIDS prevention treatment and care. With an emphasis on vulnerable groups like the bicycle operators, prostitutes, young girls who are carried to school by these operators etc.

- Increase the number of boards and stickers on bicycles ( right now we have few of these) with slogans promoting morality.

- Have an integrated sector wide approach to address the increased exposure to various diseases like EBOLA, Typhoid, HIV/AIDS, Malaria and other environmentally caused diseases faced  by the community situated on transit corridors or hubs, slum dwellers, school drop out children ( male and female). This will demand a greater understanding of the interface between transport activities and communities in these locations such as cycle race competitions, football tournamenst etc.The articulation of specific roles that community based institutions play within the context of transport interventions in order to raise awareness and promote behavioral change and the mainstreaming of these issues within transport policies and planning.

- Call for continued networking and joint action involving stakeholders with different perspectives and capacities but a collaborative agenda that addresses the needs of the most vulnerable.

- Use a peer approach through existing organisations to find solutions to the existing problems leading to contracting of diseases. To alleviate poverty by either starting up micro-credit within their reach, setting them up to access healthcare services, educating on dangers and the use of water guards and mosquito nets. .

The Nguare Bicycle Transporters Youth Group has begun to address these problems through the support of a Canadian Health Economist, Katrina Harris. The interest and well being of the affected can be solved when they are incooperated in the planning.

This opinion piece was contributed by Naboth Juma Okoth, Nguare Bicycle Transporters Youth Group
Contact: njokoth[at] yahoo.com

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