Case studies from Asia

Research study on access and mobility impacting health in low income settings in remote riverine islands (sand bar areas) in Faridpur district, Bangladesh

Study led by Shamim Hassan a programme manager with Practical Action in Bangladesh and Monsoor Ahmmmad- Field study and monitoring consultant

Background

Until now issues around mobility and access to health services have received scant research attention whereas these issueas are critical when it comes to achieving the Millennium Development Goals in Bangladesh. The research proposal is based on this to conduct an in-depth study on poor vulnerable people living in the isolated riverine islands to get a thorough understanding on the relationship between access and mobility and broad-based health aspects. This will help bring new insights to policy makers in the development sector.

Overall and Specific Objectives

The proposed research project investigates the relationship between mobility and access to health for low income or poor communities and the necessity of having access to appropriate transport modes that have impact on health, especially related to pregnant women. 
1.  To investigate the existing link of mobility and health in the development process to create a better understanding of the present situation of livelihoods of disadvantaged people
2.  To determine the potential links of mobility and health and in the development process for improvement of livelihoods of disadvantaged people
3. To explore the needs to build effective partnerships between vulnerable people and other stakeholders to raise their voices and help influence the policy makers on mobility and health aspects

Methodology

Following are the methodologies to be used for undertaking the proposed research study on mobility and health:

1. Participatory community based meeting: This will be carried outwith the riverine community to interact on access and mobility on health issues to better understand the need for access and mobility on health and embedding a sense of ownership of the study process.  
2. Meeting with related stake holders :  Effective and sustainable partnerships between communities and other stake holders like local community representatives, boat operators, mule operators, members of local government; policy makers, staff of directorate of health and other related organisations like NGO’s working in the health sector and research organisations are crucial.
3. Facilitation role of researcher/field surveyors: The facilitation activity of the researchers/ field surveyors will take the form of disseminating of information and knowledge using effective media and tools with a view to creating awareness in the target geographic area relating to mobility & health aspects of stakeholders.
4. Baseline Survey: After selection of the study villages with consultation of the community, the first steps in carrying out a study / research is to collect and review any relevant documents. The next step will be to talk with “key informants” who are knowledgeable about mobility & health. Using a standard survey tool, interviews with the stakeholders through a base line survey of  50 house holds in 5 different villages of two upazillas of Faridpur district has to be carried out to facilitate the identification of constraints and opportunities facing the stakeholders in several areas of: appropriate available transport during pregnancy, acute diarrhoeal diseases of children and elderly people, other epidemic diseases; awareness of the boat operators to meet such conditions.
5. Gender sensitivity and close involvement with the study: Special emphasis will be placed on women’s participation given that health related problems and mobility have a direct impact on women and family life. Experience shows that their full involvement is crucial if meaningful progress in developing a better health for the entire community is to be achieved.
6. Creation of data base: Access and mobility and health related issues will be entered into a data base through base line survey. Design of interventions to develop present status of mobility & health with especial  regards to Millennium Development Goal 4 and 5 (reducing child mortality and improving maternal health- see MDG; Bangladesh Progress Report 2005 )
7. Media coverage: Local and national media (printed and electric media) will be used in publicizing the workshop on health and mobility and dissemination of workshop/seminar discussions and recommendations.
8. Monitoring: Monitor the progress and out come of the activities in the context of objectives, time frame of the study will be October 2006 to June 2007.
9. Compiling of the study: Compiling of the final outcome/recommendations of the study.

Expected Outcomes of the Research

1. Developing tools to help transport professionals to consider the relationship between mobility and access to health particularly related to maternal mortality and other health problems of children and elderly people.
2. Increased mobility is associated with raised awareness and demand for health services.
3. Explore bringing appropriate health services closer to the community focusing on improved and integrated transport modes in a participatory way

Information Dissemination and Advocacy Strategy

1. Dissemination of research knowledge through holding workshop/ meetings at local, national and regional level represented by NGOs, donors, members of the civil society and government policy makers
2. Share study findings with all NFG members through IFRTD web page, print and electronic media for  national ownership of the research theme and findings
3. Develop an advocacy programme to sensitise health sector of transport issues
4. Stimulate, leading and contributing to debate at the local, national and international level based on the study outcome.

Impact of PMGSY (Prime Minister Gram Sadak Yojana) Roads on health in Rural Rajasthan, India

Study led by Ashoke Sarkar a professor at the Birla Insitute of Technology and Science and Dr. Motilal Dash (Investigator); Dr. (Ms.) Saby John (Investigator)

Background

In the year 2000, the Government of India initiated a programme known as Prime Minister Gram Sadak Yojana (PMGSY) for the construction of all-weather roads for connecting all villages having population over 500 by the end of 2007. However, the construction of a road does not guarantee its accessibility. It depends on mobility, social customs, ability to pay and the quality of service provided at the health centre. While it has been widely acknowledged that PMGSY roads have improved social, physical, financial and human capital in the connected villages, no attempt has yet been made to carry out a systematic study to quantify them.  

Overall and Specific Objectives

1. To understand the health care needs and the existing practices of meeting them in rural areas with special reference to maternal health
2. To identify the parameters to be considered for determining the impact of providing PMGSY access roads on the accessibility to health facilities of the concerned population and to develop a technique to quantify the selected parameters
3. To carry out a few case studies in selected villages in Rajasthan both connected by PMGSY and unconnected to determine the impact of these roads to health.

Methodology

The study will be conducted through participatory approach and the villagers would be involved in each and every aspect of it. The parameters to be considered for determining the impact of PMGSY roads on health would be identified through literature review and interaction with the officials of the local government, NGOs and villagers. Accordingly a questionnaire would be developed and the relevant data would be collected through survey. All the villages benefited by the construction of a road would be considered as connected. The mobility related parameters would be studied thoroughly and then compared between connected and unconnected villages to determine the impact of PMGSY roads on accessibility to health sector.

Expected Outcomes of the Research

1. To understand the health care needs and the existing practices of meeting them in rural Rajasthan and also to bring out the issues of transport- related barriers in accessing health facilities.
2. Identify the parameters to be considered for assessing the accessibility to health services including emergency needs in rural areas.
3.  Development of a technique to quantify the impact of PMGSY roads on health with special reference to maternal health.

Information Dissemination and Advocacy Strategy 

The Birla Institute of Technology and Science, Pilani is actively involved with the PMGSY programme and is acting as the Principal Technical Agency of the National Rural Roads Development Agency (NRRDA) and the information gathered through the study would be disseminated through the quarterly bulletins published by the agency.  Moreover research papers would be published in journals and presented in national, regional and international conferences.
A member of the IFRTD National Forum Group is also a member of the Rural Roads Committee of the Indian Roads Congress. Also the members are in touch with the officials of the Government of Rajasthan (Public Works Department, Department of Local Government etc.) through various training and research programmes taken up time to time by BITS Pilani. These opportunities would be taken to carry out advocacy for the inclusion of the study findings at the policy level.

A case study on Accessible Transport and Health of Persons with Disabilities in Rural areas of India

Study led by Vardhani Ratnala a Knowledge Manager in the South Asia Office of Leonard Cheshire International in collaboration with K.R Rajendra, Shivram Deshpande and Victor. J. Cordeiro.

Background

India’s disabled population at 21,906,769 (Government of India Census 2001) is more than Australia’s population. Of this figure, 75% of disabled people are in rural areas that are mostly inaccessible and have few transport or health services.
This research aims to assess current transport facilities in rural areas and how they affect a disabled person’s health and empowerment. The research will be done in 3 community projects of Leonard Cheshire International – South Asia Regional Office . The three projects are located in rural areas of India and represent different terrains; therefore, the impact of transport will be different in each area.  While one project is along the sea coast and was affected by Tsunami of 2004, the other project is on a hilly terrain with coffee estates, scattered settlements and infrequent transport; the third project is located on a national highway and has good transport.

Overall and Specific Objectives

1. To assess how accessible transport systems are to persons with disability.
2. To assess how transport affects health personnel’s reach to disabled people in villages.
3. How lack of transport facilities impacts the health and thus empowerment of disabled persons.

Methodology

As mentioned above, the study would be taken up in 3 projects – Nagapattinam, Prakasam, Coorg of India. In each project, a team comprising of the project manager, a coordinator and 3-4 development workers would collect field level data. Overall logistics, data collection coordination and video, photography would be done by a Co-ordinator (field support) – Venugopal.  Development of research tools, Training of project staff; Data analysis & Reporting would be the responsibility of principal investigators.
The team will adopt the following research levels:
1. Transport (a) Public (b) Private looking at frequency, route mapping and overall accessibility through secondary data and semi-structured interviews  
2. Persons with disability and their families and wider community  Domains of enquiry – Difficulties faced in accessing transport for health needs, rating of transport systems on accessibility features, Discrimination, Attitudes of transport operators, Suggestions for improvement, Health infrastructure and access…….
Sampling: Selection of disabled persons and family members will be done ensuring representation of all disability groups as far as possible. Age and Gender representation will be ensured. Purposive sampling methodology will be used. The team will do focus group discussions as well as surveys
3. Health Personnel
Domains of enquiry – Health needs of disabled people, transport issues in providing medical care, disability incidence, Health infrastructure..…..
Sampling: staff of the nearest primary health centre would be interviewed through semi-structured questionnaires.

Expected Outcomes of the Research

1. The case study would give us conclusive proof on importance of transport in the lives of persons with disability and thus, help us advocate and lobby with public and private transport operators for affirmative action.
2.Provide us solutions on how transport can be made accessible especially to meet emergency health needs of disabled people.

Information Dissemination and Advocacy Strategy 

The findings from the study will be widely disseminated by LCI-South Asia office through its quarterly newsletter “EMPOWERED”. In addition, we will come out with an exclusive publication of the findings and a workshop will be held with participation from local transport authorities, public and private transport owners and NGOs to discuss on future mode of action.

Mobility in Relation to Maternal and Child Health in the Manggarai district, Eastern Indonesia

Study led by Tarsis Hurmali a coordinator with AYO Indonesia a local NGO in Flores with his team member Karen Whitby

Background

Indonesia has one of the highest maternal and infant mortality rates in south Asia (MMR at 307 deaths per 100,000 life births and IMR at 35 deaths per 1,000 life births).  More interesting though the further we travel east in Indonesia the worst the situation becomes, for example in NTT (the south eastern islands) the MMR is 554 deaths per 100,000 life births (80% higher than the national average) and IMR is 59 deaths per 1,000 life births (68% higher).

But it's not only the health situation which worsens the further we travel east but also the infrastructure, according to the local data 50% of villages are classified as inaccessible by public transport during the dry season only, This will increase during the wet season.  Therefore we propose to research what influence the local infrastructure has on the MMR and IMR.

Overall and Specific Objectives

1. To find out how mobility (quality of infrastructure, availability of transport and remoteness of village location) affects the accessibility of the health services
2. To find out how the quality and availability of the health services influences the level of accessibility of the health services
3. To find out how the local culture affects the accessibility of the health services (including gender issues, local beliefs, etc)

Methodology

There is limited research and knowledge available on mobility and health and its influencing factors. Therefore, we propose to research how infrastructure (distance, travel time, etc), availability of health services (types of services and quality), acceptability (gender, ethnicity) and affordability (costs and socio economic situation) influences mobility and health focussing on maternal and child health
The proposed research methodology include several approaches such as focus group discussions, surveys and interviews at village level and sub district level (medical staff), collecting data from the village, local health centre and district health facilities.

Expected Outcomes of the Research

1. To have gained an understanding of how mobility (quality of infrastructure, availability of transport and remoteness of village location) affects accessibility of the health services
2. To have gained an understanding of how the quality and availability of health services influences level of accessibility of the health services
3. To have gained an understanding of how the local culture affects accessibility of the health services (including gender issues, local beliefs, etc)

Information Dissemination and Advocacy Strategy 

Once the research study has been completed NGO Ayo Indonesia plans to organise a seminar to which the appropriate government departments and other local institutions will be invited.  The aim of the seminar is to invite the government and local institutions to look at their policies in relation to mobility and health issues and use the results from the research study to advocate changes of the policies at regional level.  The seminar will focus on infrastructure policies and heath policies which are related to the outcomes of the research study.  The process will be facilitated by the existing good working relationship between government and NGO Ayo Indonesia in the field of health and infrastructure.   
Beside the seminar the results will also be published in the local newspaper and NGO Ayo plans to hold a talk show on the local radio station to raise awareness among the local population about the existing situation mobility and health. 
Finally, NGO Ayo Indonesia will also use the outcomes of the research study for changing its own policies for the infrastructure component as well as the health component.

Impact of Transport Interventions on Health-related issues for Marginalized groups. Case Study: Trail bridges built under the Trail Bridge Sub-Sector Project (TBSSP). Nepal

Study led by Ansu Tumbahangfe and her team members Dr Devendra Chhetry and Mr Jan Roukema

Background

In Nepal, a rugged topography along with low levels of basic infrastructure and inadequate road networks has undermined the delivery of health care services to rural areas. The lack of medical staff in healthcare service centers together with unsatisfactory supply and maintenance of equipment and medicine have been identified as the chief reasons for the poor quality of services (NHDR 2004). Highly uneven distribution of available services also exacerbates the situation, especially in the mountain region where foot trails are the main mode of transport. Women and children are among the most vulnerable groups affected. Maternal mortality is at 539 deaths per 100,000 women aged 15-49 years, one of the highest in the world. 27 percent of all deaths of women aged 15-49 years are attributed to childbirth complications, mostly due to low level of access to antenatal, delivery, post-natal care and abortion complications (UNDP 2004)

Overall and specific objectives

The study will focus on trying to understand the interplay between transport interventions i.e. trail bridges and its impact on health related issues for rural disadvantaged and marginalized groups at the micro-level.
Specifically it aims to:
1. Understand the mechanisms by which increased mobility provided by the trail bridges have affected the health situation of rural women, children and marginalized groups.
2. Identify and understand how increased mobility affects or does not affect the health views and practices of communities where strong indigenous beliefs exist.
3. Appraise if safe and easy crossings is the only barrier for the disadvantaged groups to acquire basic health care services.

Methodology

The research methodology will involve assessing the impact of trail bridges on health related issues for disadvantaged groups in various social and geographical settings. A select number of field sites will be visited. Cases will be selected from among 10 districts of the Eastern, Western and Far-western regions of Nepal for which Post Bridge Building Assessment has been done in 2005. Project related documents will be reviewed. The primary source of information will be qualitative data collected from field sites. Indicators will be developed and rapid rural Appraisal methods consisting of Focus group Discussions, Key Informant Interviews and Observation will be conducted both at the community and the household level with relevant checklists. The findings will be documented in digital formats. Consultation with the various health programs/projects will also be conducted so as to capture their learnings. District level data will be assessed from the secondary sources. Any baseline information through documentation at the project office will also be taken into account.

Expected outcomes of the research

One of the most important outcomes of this study will be the generation of a much-needed knowledge base regarding the transport sector and its impact on health. The study seeks to fill in the knowledge gaps that exist by focusing on one form of transportation i.e. trail bridges with a view to generate knowledge and ideas to support and give direction to development plans and policies.

This research will also act as a supplement to previous studies (Post Bridge Building Assessments) of the TBSSP bridges. While the PBBA focused on quantitative analysis of sampled projects, this study would provide a more in-depth analysis. By focusing on gender issues, new light will be brought to an otherwise neglected area.

An added value of this study would be the feedback that it will provide to TBSSP/Helvetas and the local government of whether the selection criteria (based on which the proposed trail bridges are constructed) are effective in addressing the health related priorities.

Information dissemination and advocacy strategy

The outcomes of the study will be disseminated at the local and national level. At the local level, it will be done through local level Mother’s groups, Community Base Organisations, Advocacy groups for the disadvantaged groups and schools. Through such events, awareness will be created among disadvantaged groups to advocate for their health needs, provide access to health services, etc. This study is also expected to help identify the issues related to the access/barrier to basic health care services.

At the national level, findings will be shared and interaction with the policy level institutions will be made so that effective policy measures can be framed to better serve the underprivileged groups from the rural community.

The effects of restricted access on maternal health in remote and mountainous areas of rural Nepal: the DRSP experience, Nepal

Study led by Binjwala Shreshta and team members, Ms. Sangini Rana Magar and Mr. Robin Workman

Background

Nepal is a mountainous country, with an average poverty level of 42%. Due to inaccessible terrain and lack of transport infrastructure, poor people find access to health services very difficult and expensive. A number of programmes are addressing these issues, from both the physical access and the health perspective, although not in association with each other. Maternal mortality comprises a large percentage of deaths in Nepal and recent research suggests that this situation is exaggerated by restricted access. There is scope for research that will pull all of the different experiences together and present a consolidated paper on the subject

Overall and Specific Objectives

1. To gain a more in-depth understanding of how restrictions in access affect health, and in particular maternal mortality.
2. To make recommendations as to changes in transport linkages and connectivity in rural and mountainous areas, including transport to health facilities, use of ambulances, types of vehicle appropriate for transporting expectant mothers, etc.
3. To influence more appropriate policy development regarding accessibility, especially to rural areas.

Methodology

Access to health facilities is very difficult for poor people living in rural and hilly areas. The World Bank and DFID proposed incentive payments for women to use health facilities by paying up to Rs1,500 for each woman who attends a registered health facility to give birth, this has since become government policy. Most of this payment goes towards the transport costs.
Quantitative and qualitative approaches will be used to explore the health and mobility practices of the community. This will involve talking to expectant mothers and mothers who have recently given birth, plus other family members. The researcher will use semi-structured interviews in household surveys, key informant interviews, social mapping, record review and case studies in order to collect the necessary data. Also primary / secondary data will be collected regarding:
1. socio-economic, demographic and reproductive background of mothers and their health care seeking practices, antenatal, natal and post natal
2. maternal mortality and morbidity case studies in each district, desegregated by ethnicity and disadvantaged groups.
3. the availability, cost and accessibility of health centres and birth attendants
4. the frequency and cost of public transport and other transport to remote areas
5. the availability and cost of ambulances / emergency access to remote areas
6. the extent and condition of the existing rural road network, linked with distances to health facilities.

The researcher will aim to collect data from a sample of 300 - 400 people in each district, with a mix of mothers, fathers and mothers-in-law (whom the mothers usually live with). The study will focus on disadvantaged groups and conflict affected areas. Local facilitators will be used, some of which already have links with DRSP and RHDP.
The researcher will collate all of the information and determine the major effects that restricted access has on maternal mortality. In many cases there are locally developed innovations that address the issue of providing access to health facilities. The researcher will endeavour to expose such innovations and see how they can be further developed to provide more sustainable access to maternal health facilities in rural Nepal.

Expected Outcomes of the Research

1. The research aims to contribute towards the knowledge base on mobility and health. There are several possibilities to disseminate such research outside of Nepal, such as the TransNet, the IFG meetings, IFRTD and TRL, etc. There will also be opportunities to disseminate the findings in the wider health sector, both inside Nepal and abroad.
2. The research aims to achieve an increase in awareness of mobility issues with regard to health. It will take an intensive awareness campaign to convince people of this and an effective research project will be able to back this up.
3. Central government already has a detailed plan for development of the road network, but this is not necessary linked to health requirements. The research will comment on the proposed development of the rural road network with respect to health and maternal mortality, and aims to influence more appropriate policy development regarding accessibility. The outcome will be to have more appropriate integrated policy on health and mobility in Nepal.

Information Dissemination and Advocacy Strategy

DRSP has supported central government in the past in developing a number of policy documents. DRSP is also acting secretariat, and an active member, of the Rural Roads Forum (RRF) in Nepal. The RRF is an independent group that advises the Government of Nepal (GoN) in good practice and policy matters. .
Through this established forum the results of the research will be disseminated to GoN via a recognised channel. DRSP is very active in this area and GoN readily accepts advice and guidance from the RRF. The Director General of the Local Infrastructure Department regularly attends meetings and requests advice from RRF members.
DRSP also has established links in six districts, as well as being involved in a new project that will extend its influence to 18 more districts. DRSP can utilise these entry points to disseminate the research information at the local level. In addition if the research affects policy development, central government will have to ensure that this is effectively disseminated in the districts and villages. The regular DRSP public hearings can also be used for dissemination purposes.

Economic Benefits of Non-motorised Intermediate Means of Transport (IMTs):
Case Studies of Rural Nepal.

Study led by Jun Hada a programme manager with Practical Action Nepal.

Background

Maternal mortality rate is very high (415 deaths per 100,000 births) in Nepal mainly due to poor access to primary health care facilities. Likewise, the cases of child and other mortalities due to different diseases and accidents are also very high due to poor access to health care facilities.  Till date the government’s focus is on the preventive and curative community health care facilities whereas their issues of accessibility have always been neglected. Therefore, there is a need of serious attention regarding the improving mobility and transportation of sick people from their home to a primary health facility centres. The experience of Practical Action Nepal shows that little investment in IMTs can contribute significantly in solving rural access problem contributing to improved health.

Overall and Specific Objectives

1. To establish a functional relationship between mobility and the health with key indicators.
2. To produce basis for the monetary (financial and economic) valuation of the interventions on alternative transport systems and health burden reduction
3. To check the economic viability of investments in alternative means of transport in terms of health improvement

Methodology

Primary data and secondary information will be used in the research. Primary data will be collected through field surveys in two selected districts i.e. Dhading and Siraha where the interventions of tuins and bicycle ambulances were carried out. At least 60 households will be selected purposively in each district for household survey. Among 60, 30 beneficiary households of tuins will be selected for impacts assessments whereas 30 households without tuins services will be surveyed for their accessibility needs and their health costs. Similarly, 30 benefiting households from the bicycle ambulance users will be surveyed on the health benefits of bicycle ambulances whereas 30 households without access to ambulance services will be surveyed on their overall mobility status and their health costs. To analyze gender sensitivity of the interventions, separate focus group discussions will be held with women and children groups.

Related health and transport information will be reviewed focusing on the rural access and health impacts. The District Transport Master Plans (DTMPs), Nepal Transport Sector plans and policy, PRSP and reports of MDGs will be reviewed. Moreover, The National Health Sector Strategy 2004, Nepal Family Health Survey 2002, Nepal country Profile on Women, Health and Development 2001, will be reviewed to assess health situation and their relationship with mobility.

Focus group discussions will be held in each selected district with beneficiary and non-beneficiary groups. In addition, health data will be collected from local health posts/centres to validate the responses.

Followings are the research questions for this proposed 10 month project:
(i) Does improved mobility contribute to improved health? Are mobility and health correlated significantly?
(ii) Is the investment in IMTs viable in context of improving health (decreasing  mortality and morbidity), time saving and health cost saving?

Collected data will be analyzed using SPSS computer statistical analysis package. Econometric analysis will be done to analyze the significance of IMT interventions on health improvement. Cost benefit ratio will be calculated using standard discount rate of 12 percent. Similarly, Internal Rate of Return (IRR) will also be calculated. To check the robustness of the results and risk associated with the benefit and cost, sensitivity analysis will be carried out.

Expected Outcomes of the Research

1. Established a functional relationship between mobility and the health (strong basis will be produced for the monetary valuation of the interventions on alternative transport systems and health)
2. Economic viability of investments in IMTs checked
3. Generated policy recommendation on mobility options and preventive interventions incorporating mobility aspects.

Information Dissemination and Advocacy Strategy

The research findings will be shared at Nepal Forum of Rural Transport Development (NFRTD) members’ meetings. Practical Action Nepal is the founding member of the Forum. The Forum members are from I/NGOs, government organisations, private sectors, professionals and specialists involved in the field of rural transport development.
The research findings will be also be shared at the IFRTD workshop.  Moreover, the research findings will be used to sensitize concerned stakeholders by bringing together the national and local government authorities working in the health and transport sectors to see development approaches in a more holistic manner. It will do so by building mutual coordination and stronger linkages between both health and transport sectors through influencing them with the evidences of research findings. The fact found from the study would be helpful in designing and planning the projects in different levels of government and other institutions. In the context of the country where the national transport plan heavily focused on the construction of road and bridges, the study would play a catalytic role for the promotion of the IMTs in the policy level, so the gap in the policy would be narrowed.

A Research into the Health Impacts of Community Based Transport interventions in Pakistan

Study led by Abdul Shakoor coordinator of Shehersaaz an IFRTD-affiliated network in Pakistan and Ms. Almas Saleem (Gender Expert), Ms. Sobia Humera (Medical Doctor), Mr. Khadim Hussain (Community Development Expert) and Mr. Rana Muzaffar Iqbal (Rural Sociologist)

Background

1. The in-place local government ordinance in Pakistan contains useful policy points to accommodate people’s participation in development.
2. Provision of health and mobility services at local level is among the top most responsibilities of the local governments. 3. Most of the projects undertaken by local governments in last five years reflect a general lack of accommodation for people’s needs and aspirations.
3, Some small mobility solutions; planned, implemented and managed by communities are found to have altered the whole development outlook of the area bringing benefit to people’s livelihood and health.
4. The proneness of a community or area to disasters usually provide an excuse to the authorities not to invest in infrastructure and other facilities as the investment is thought to be washed away in the hands of disasters.
5. Local governments lack a planning tool or framework that could help them understand linkages between people’s health and mobility needs while designing mobility and health related projects.  

Overall and Specific Objectives

1.  To compare and analysis the impacts of small scale (community led) and local government driven mobility interventions on poor people’s livelihood in general and on their health in particular
2. To understand the role of mobility and health services in increasing or decreasing the vulnerability of different groups in a community to disasters.
3. To document at least two case studies from four different geographical locations (mountainous, riverine, desert and coastal) in Pakistan to develop a framework of interventions related to people’s mobility and health for local governments, Citizen Community Boards (The community based organisations given legal and administrative cover under new local government system) and other stakeholders at local level.

Methodology

The proposed research shall explore various dimensions of health impacts of transport interventions made by community based organisations/communities and local governments at eight different disaster prone rural locations of Pakistan. Two case studies shall be selected from each of the four provinces of Pakistan. Each case study or set of case studies shall represent different geographical settings (mountainous, riverine, coastal, and desert). Out of two case studies from each province/geographical location, one shall represent an intervention made by some community or CBO while the other shall reveal a project initiated by a local government in the same province in similar settings.

The administration of questionnaires will be followed by community sessions for collecting community focussed information through Participatory Rural Appraisal (PRA) tools. Focus group discussions (FGDs), wealth ranking, priority ranking, and problem and need matrix, problem tree, transect walk, case studies etc shall be the main information collection tools. During the interaction especially with the communities, participant observation will be carefully employed to assess the real problems, benefits, impacts etc.

The information shall than be analysed with in the framework of research which will be developed before collecting the information and will be refined during the course of information generation. In the light of analysis a planning framework will be evolved to help local governments and other stakeholders to improve their mobility and health related plans and interventions by having a better understanding of the two variables, their related issues and their interplay.

Expected Outcomes of the Research

1.Real world and localized examples of good and bad practices, to make a case for both policy makers and implementer for looking seriously at the linkages between mobility and health indicators and their interplay,  are documented.
2. Some of the knowledge gaps,  on role of mobility and health in increasing or decreasing the  vulnerability of different groups in communities and how the vulnerability to disasters lead to poor livelihood, health and mobility issues of the communities, are filled.
3. A planning framework/model is developed to help local governments and other local level stakeholders better plan their mobility and health related initiatives.

Information Dissemination and Advocacy Strategy

The findings of the research shall be disseminated to the wider audience at local, national and regional levels employing the following means:
1. The website of RDPI, Duryog Nivaran, Shehersaaz and other partner organisations.
2. Contributions to local and national print and electronic media
3. Through email news services
4. Through generating information on relevant email groups
5. One to one interaction with key stakeholders at local, national and regional levels
6. A presentation to National Reconstruction Bureau (the national level institution responsible for designing model rules for local governments), Decentralisation Support Programme (an institutional mechanism that provides funding to local government) and other relevant institutions
7. Networking with Pakistan Medical and Dental association, Pakistan Medical Association etc.
8. Mobilising graduate and post graduate students of Public Health, social science and development subjects to adopt the topic for their research assignments etc.