Addressing Delay 2: Transport and Communications To Improve Access to Obstetric Care Daniel Murokora May 5, 2014 What Worked, What Did we Learn, How to Improve
Regional Health Network Model SERVICES HCIV, Hospitals and Regional referral hospitals: 1. C-Section 2. Blood Levels III & private clinics 1. Basic emergency Ob & newborn care 2. PMTCT & HAART 3. Links with family planning, postabortion care, malaria, nutrition Level II: 1. Antenatal care Level I: 1. Birth preparedness District Health Office Leadership, Management, Coordination Regional & General Hospitals Health Centers & Private Clinics Level III and IV (CEmOC) Health Centers Level II (BEmOC) Village Health Team Level I
Human resource management Regional Health Network Model District Health Office Leadership, Management, Coordination Regional & General Hospitals & HC Ivs (CEmOC) Lab system Interventions Essential medicines system Infrastructure, equipment, commodities, supplies, Mama Kits in facilities Health Centers & Private Clinics Level III (BEmOC) Blood supply system HMIS, registration of all pregnancies, births, deaths in facilities Voucher system Emergency transport & communications network Health Centers Level II Village Health Team Level I Performance quality improvement, training, mentoring, supervision HMIS, registration of all pregnancies, births, deaths in communities
Human resource management Regional Health Network Model District Health Office Leadership, Management, Coordination Regional & General Hospitals & HC Ivs (CEmOC) Lab system Interventions Essential medicines system Infrastructure, equipment, commodities, supplies, Mama Kits in facilities Health Centers & Private Clinics Level III (BEmOC) Blood supply system HMIS, registration of all pregnancies, births, deaths in facilities Voucher system Emergency transport & communications network Health Centers Level II Village Health Team Level I Performance quality improvement, training, mentoring, supervision HMIS, registration of all pregnancies, births, deaths in communities
LOGIC MODEL for TRANSPORT and Communication Increase Access to Reliable Emergency Medical Transportation in SMGL Use Telecommunication to improve emergency response, coordination, reporting and Tracking Utilise Information Technology, vouchers and leverage district and community transport to strengthen emergency transport systems Use Vouchers for reimbursement Increased Access to emergency transport at community & health facility levels Deploy Robust but affordable emergency vehicles (Ambulances, Bodas, Taxis and District Vehicles Deploy Robust vehicles owned by community and Districts Obstetric complications treated within 2 hours reduction in obstetric CFR Newborn complications treated within 2 hours reduction in neonatal CFR Improved access to quality obstetric/newborn care leads to reduction in maternal-newborn deaths
5/2/2014
FLOW CHART of pregnant mothers from community to health facilities At first signs of labour, pregnant woman or care taker calls VHT or boda directly VHT calls Boda transports to HC III in catchment Midwife receives mother, signs boda log book, stays with copy assesses mother Is referral necessary Pregnant mother managed at HC III Midwife calls E-ranger or ambulance Mother taken to referral HC IV or hospital 5/2/2014 Mother discharged
Communication system 1 VHT per village on CUG ( Question is do we procure mobiles for them? Baylor regional staff Boda, E-ranger, hired vehicles and Ambulance on CUG District staff on CUG (CDO, health educator,???dho, district doctors and Anesthetic officers) Fixed Phone in 120 HFs maternity or theatre 5/2/2014
Increased access to high impact maternal health services Support transportation network Support mobile technology communications Community Transport Inter-Facility Transport Caller User Group
Transport inputs as at June 2012 June 2013 7 vehicle ambulances functionalized 16 Tricycle ambulances 29,892 vouchers in all districts (Service; Transport; BFM; 10,000 Healthy Baby Voucher
Communication and Transport
Voucher program (transportation & delivery)
Modeled time to access CeMOC services in SMGL Districts Access within 3hrs by walking & motorised 1. CEMOC Access increased: 13% to 68% 2. BEMOC Access increased from : 24% to 87%
What Worked District Led Ambulance Committees streamlined management Boda for Mothers were Affordable Districts made their vehicles available Taxis in the community readily available Women were able to call for help (either Boda and Ambulance) and be picked
What Did We learn Transport Incentivized Demand for services Communities can participate in transporting of women Taxis were quite costly Potential for fraud in use of taxis Tri-cycle ambulances are affordable but not appropriate for off-road use Tricycle ambulances can be assembled in-country 4x4 Land cruisers have high initial costs and maintenance costs Phones can have charging problems and lay idle
SMGL Tricycle Ambulances Assembled in Kampala Has a wider base and large cargo space
Poor Roads Even The Best 4 x 4s had trouble navigating the difficult roads!!!
How To Improve Integrate maintenance costs of emergency transport into district budgets Strengthen district ambulance management committees and have a call centre to manage the regional ambulances Mobilize communities to save funds for emergency transport Put in place checks and tracking of transport vouchers and vehicle management systems Ensure phones are adaptable to places without power, e.g solar charging Lobby districts and Ministry of works to improve road maintenance