Systematic Review: Referral Systems for EmOC

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DFID, partnering with IMMPACT and others, recently published, a systematic review that delves into the evidence on transport and referral systems for emergency obstetric care (EmOC). The review covers 14 interventions that address organizational problems, structural issues or a combination of the two. The organizational interventions included creating emergency funds through community groups, educating women and traditional birth attendants, and improving facilities. Structural interventions included establishing maternity waiting homes, improving transportation and enhancing radio communications.

After discussing and analyzing the interventions, the authors recommend:

while continuing to invest in implementing referral interventions within maternal and newborn health programmes, we urge health planners to ensure that the interventions are rigorously monitored and evaluated, or operations research studies designed with controls and comparisons. Secondly, we believe that our finding of the reduction in stillbirth rates in maternity waiting home interventions needs further exploration through well-conducted studies, as the finding was based on studies with suboptimal study designs subject to biases. Finally, we believe that the type of research most relevant to referral interventions for policy and practice is not based on questions of ‘what works’, but should aim to understand how the interventions work and