A ten-hour walk for a medical check: poor access to health centres threatens the lives of pregnant women

Travelling 54 kilometres by foot for a pregnancy check. Unthinkable? Unfortunately, this is the reality for millions of women in the world’s most fragile areas. They can’t access essential healthcare services, with life-threatening consequences. In many cases, the distance to health facilities is the biggest challenge. The good news is that there are ways to solve this problem. 

Chanceline softly sings a traditional song from her region as she prepares for the long journey. It is the rainy season, so besides food and water, she adds an umbrella and some dry clothes to her inventory. She waves goodbye to her husband and two young children and steps outside the house, onto a path of red sand meandering through endless, bright green hills. 

Chanceline isn’t travelling for work or embarking on a fun, relaxing weekend trip; today she’s undertaking a ten-hour journey there and back for a medical check-up that will last just a few minutes. 

26-year-old Chanceline lives in the region south of Lake Kivu, which forms the natural border between Rwanda and the Democratic Republic of the Congo. She is due in two months and wants to visit a doctor to make sure her baby is healthy. 

However, the nearest health centre is 27 kilometres away; a journey over steep, muddy roads, even difficult for motorised vehicles to access. 

Few countries in the world are as vast and full of inhospitable landscapes as the DR Congo. And people live in all the remote corners of this immense country in the heart of the African continent. 

Facts and figures maternal health in Africa

Conflict, poverty and drought 

Despite their admirable self-reliance, Congolese people regularly face major crises that are impossible for anyone to cope with. For instance, a violent conflict in the east of the country has been threatening the lives of millions for decades, the majority of the population is living in extreme poverty and climate change is increasingly endangering food security. 

‘On the day of my daughter Anne’s birth, there were serious complications.’

In the DR Congo, life for women in general – and pregnant women in particular – can entail additional threats. Sexual violence is commonplace in conflict areas and a pregnancy can pose great risks due to a lack of good health care. 

‘Life in our village is hard,’ says Chanceline. ‘Especially if you don’t have enough resources. You don’t want to live here if you are sick. It would be good if everyone had access to healthcare.’ 

This was nine years ago…. 

The Walk 

Chanceline’s quote comes from a trailer for The Walk, a 2015 film billed as ‘The most boring video ever’. The camera follows Chanceline for five hours during her entire journey to the nearest clinic. The film was part of Cordaid’s awareness campaign about the dire situation of people who need care but cannot get it. 

Need to unwind from a stressful day? Watch The Walk and travel for five hours with Chanceline to the health facility.

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‘Distance still is our biggest problem,’ says Immaculée Mulamba Amisi, coordinator of Cordaid’s healthcare programme in the DR Congo. ‘In a well-functioning system, everyone should live within five kilometres of essential healthcare services. Unfortunately, this is often not the case. The time it took Chanceline to get to a clinic is no exception. Due to the poor condition of the roads, even a journey by car can take hours.’ 

Dangers along the way 

Many pregnant women therefore decide to skip the necessary medical consultations, which means that complications may not be discovered in time. Women who do undertake the long journey run great risks. Overtiredness and overheating are just some of the dangers that can occur along the way. 

Immaculée: ‘That’s why many women choose to give birth at home. In those cases, there is no professional help available at all if something goes wrong. When they walk all the way to a medical centre, there is also a risk of complications or even childbirth en route. Some women, when they finally arrive, are completely exhausted, which can also be dangerous in their condition. The harsh reality is, because of the large distances to health care, we see mothers and children dying.’ 

‘Our approach also improves health care in general. We train qualified staff and provide the necessary materials and equipment.’

Waiting houses 

Some health centres are trying to solve this problem by building waiting houses. In the last month of their pregnancy, women can remain there until a few days after giving birth. ‘This sounds good, but unfortunately, it is often not a workable solution,’ says Immaculée. ‘Especially not for women who already have children, like Chanceline. There is not enough room in the waiting houses for the whole family, so the mother has to leave her children behind for a long time. Income is also an issue. Many women here are farmers. When they leave home, the work stops and so does the food supply.’ 

Together with the World Health Organisation and other development cooperation organisations, Cordaid has been proclaiming for years that healthcare is a human right and must be available and accessible to everyone, everywhere. The member states of the United Nations have agreed to strive for universal access to health coverage by 2030. 

To make this happen, the international community must step up their game and put in some serious effort. Immaculée still believes we can achieve the sustainable development goal if we act quickly. ‘Firstly, we must construct good roads to improve accessibility. Not only from the remote villages but also from the health centres to the hospitals where we refer the more urgent cases.’ 

Innovative solutions 

Immaculée is particularly excited about an innovative solution in which healthcare workers are trained within remote communities. ‘They can provide basic care to pregnant women and relieve the burden on the health centres by solving many problems directly on site. They will still send the more urgent cases to the clinic.’ 

Modern technology can also offer solace. Cordaid is working on a pilot project in which people in remote areas receive crucial medical information on their smartphones. Urgent cases can be referred to the hospitals relatively quickly and easily. 

Immacculée: ‘Our approach also improves health care in general. We train qualified staff and provide the necessary materials and equipment.’ 

Results-based financing 

Cordaid sustainably strengthens healthcare systems in DR Congo and several other countries, such as Uganda, Ethiopia and South Sudan, through a results-based financing programme. This means that when healthcare facilities achieve certain pre-agreed results, such as improving access or organising special transport, they will receive extra funds. The health centres then invest this money in improving their services and the quality of care. 

Facts and figures Cordaid health care programmes

After filming The Walk, the rest of Chanceline’s pregnancy and her delivery were certainly not without worries. ‘On the day of my daughter Anne’s birth, there were serious complications,’ says Chanceline. ‘The umbilical cord came out before the baby, which is very dangerous. The nurse arranged a motorcycle taxi to take me to the hospital of Denis Mukwege (the 2018 Nobel Peace Prize winner with whom Cordaid also collaborated on a healthcare project -ed.) in Bukavu. They helped me there and, in the end, I gave birth to a healthy baby.’ 

Improvements and challenges 

Afterwards, Chanceline and Anne regularly visited doctors for check-ups and the necessary treatments against childhood illnesses and a malaria infection. From her current home, she can reach the health centre more easily by taxi. 

Despite the many improvements, Chanceline also sees some major challenges for Congolese healthcare in the coming years. ‘The services have improved noticeably. Buildings have been renovated, more materials are available, and the employees are skilled. But the high costs are still a problem for many people. We have too little income and the transportation to the health centres isn’t cheap.’