A Neglected Topic: Emergency Transport and Referral Systems to Improve Access to Maternal Health Care

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By: Ana Luisa Silva, Transaid

As we get to the end of the Global Maternal Health Conference 2013, a three-day opportunity to discuss issues and share experiences on improving quality of maternal health care, I would like to highlight one of the topics that was given a space for discussion in this conference: transport and emergency referral.

I was really pleased to be able to attend three panel presentations dedicated exclusively to emergency referral systems in developing countries, one of them focusing entirely on transport interventions to improve maternal health. In many other panel presentations and poster presentations the lack of transport was identified as a key barrier to accessing maternal health care; from antenatal care (ANC) to emergency obstetric care (EmOC) and post-partum care.

Despite this, most maternal health programmes and policies in sub-Saharan Africa and a substantial amount of maternal health research, still focus on the first and third delays that women experience when attempting to access EmOC (decision-making at the community-level and receiving appropriate care at the facility level, respectively), while the second delay (travel between the community and the health facility) is often neglected.  In the hope that these emergency transport and referral system topics will receive more interest in the future from policy-makers and implementers, I would like to summarise some of the key messages from the panel sessions’ discussions on emergency transport and emergency referral systems:

  • The lack of adequate and affordable transport is being increasingly acknowledged as a key barrier for women to access health facilities with appropriate EmOC. This happens particularly in remote rural areas of sub-Saharan Africa, where geographical contexts are challenging (poor rural roads, mountainous terrain, areas isolated during the rainy season), distances are long (between communities and health facilities or between the different levels within the health system) and the availability of transport is limited (transport in general and transport for medical emergencies in particular). However, a few presenters observed that in urban areas transport-related factors such as high levels of traffic and unreliable and unaffordable public transport, especially at night, are also becoming a significant constraint affecting access to emergency health care in the increasing urbanised developing world.
  • At this conference, details of a number of different transport and access interventions that have been implemented recently in a range of countries were presented (including work from my own organisation, Transaid, amongst many others), showcasing a growing toolkit of options available for maternal health programmes to tackle the challenge of access for maternal emergencies. Some interventions focused on health facility-based transport, while others established community-based modes of transport and even a few projects explored the possibility to work with the private sector. They represented an ability to intervene at different levels and make emergency transport more adequate, more available and more affordable for women living in rural and urban settings of developing countries.
  • Despite this growing toolkit, there remains a substantial challenge to evaluate the impact of emergency transport and referral system interventions in order to assess the health impact of investments in such tools for maternal health programmes and policies, a subject which led to an interesting discussion, particularly during the Tuesday session on emergency referral systems. This is an area where researchers from a range of disciplines, programme implementers and policy-makers need to collaborate and resources need to be targeted in order to facilitate such collaboration, so that successful emergency transport interventions can be identified and considered decisions can be made about investments in this important area.
  • Finally, it is important to keep in mind that emergency transport is a part of an overall referral system and thus emergency transport interventions should be integrated with efforts to improve referral linkages and communication between the different levels of referral, with efforts to capture the developments provided by rising mobile phone penetration and with efforts to increase women’s access to finance through community credit schemes for health and livelihoods more generally.

These are only some of the key messages that have been shared during the panel presentations and they show that there is already much to learn from, but still a need to focus more effort and resources to make sure that more programmes and policies integrate emergency transport and referral systems as key components.

As Ana Langer, the Director of the Maternal Health Task Force, observed in her closing remarks to the conference participants, “there is no point in having a well-equipped and well-functioning facility offering quality maternal health care – if women can’t reach that facility”.

Please take the time to visit the conference website and have a look at the three panel sessions which addressed topics related to transport and referral systems:

Learn more about the conference and access additional conference presentations at www.gmhc2013.com.

Join the conference conversation on Twitter: #GMHC2013