|Affiliation(s)||1Healthcare, Kissito Healthcare, Inc., Roanoke, United States.|
|Country - ies of focus||Uganda|
|Relevant to the conference tracks||Health Systems|
|Summary||Achieving the fifth Millennium Development Goal (MDG5) by reducing maternal deaths remains a significant challenge in Uganda. Uganda has a high Maternal Mortality Ratio (MMR) of 438/100,000 live births with the life-risk of 1 in 27 women dying in pregnancy. One of the many underlying factors that contribute to high MMR in the country is delay in reaching an emergency obstetric care (EmOC) facility. Evidence indicates that access to appropriate health care, including timely referrals to EmOC services, can significantly reduce maternal deaths.|
|Background||Ensuring timely access to quality EmOC for women with obstetric complications are increasingly recognized as priority interventions needed to reduce maternal deaths. To reach EmOC services, one of the vital factors is the availability and accessibility of suitable and affordable transport. Delay in accessing and receiving EmOC is a major predisposing factor for maternal deaths in rural Manafwa and Mbale districts in Uganda. The high prevalence of maternal illnesses, and other emergency obstetric complications suffered by women in these two districts have been linked to their poor access to emergency obstetric services. Earlier studies indicate that motorcycle ambulances reduce the delay in referring women with obstetric complications where health centers have no access to other transport or means of communication. In order to reduce the referral delays in Manafwa and Mbale districts, Kissito Healthcare International partnered with PONT (UK based charity) to implement a pilot project where five specially designed eRanger motorcycle ambulances were stationed at 5 remote health centers for transporting obstetric emergencies to the health facilities.|
|Objectives||The objective of the project was to assess referral time, acceptability, and feasibility of motorcycle ambulances (mAmbulances) for referral of obstetric emergencies to the nearest Health Facility and to compare the referral delays and costs with those of a 4WD vehicle ambulance.|
|Methodology||Five mAmbulances were placed at 3 remote rural health centers in Manafwa (Bubutu, Bugobero and Bushika) and 2 health centers in Mbale (Busiu and Wanale) districts for transporting obstetric emergencies and other emergency cases to the health centers free of cost.
At each health center drivers were recruited and trained over 2 weeks to drive the mAmbulance, to be responsible for its maintenance , and on data recording in logbooks.
Community volunteers were identified, trained , and provided with pre-paid mobile phones to call the mAmbulance in case of an emergency for transport to suitably equipped health centers.
Data was collected over a 17 month period, from January 2011 to May 2012 using logbooks, referral forms, and maternity registers.
Specially designed referral forms were used to record data on all emergency referrals, irrespective of means of transport.
Specially designed logbooks were filled in by the drivers of the motorcycle ambulances recording data concerning all trips, including departure and arrival times for the patients referred.
The maternity registers at the health centers were used to identify all referred obstetric cases and the reason for referral.
Semi-structured interviews were conducted with health workers, ambulance drivers about transport issues, referral procedures, and referral delays
|Results||The mean duration of referral to reach a health facility for all emergency obstetric cases varied between 1:01-1:09 hrs.|
|Conclusion||In resource-poor Uganda, mAmbulances are a useful means of referral for emergency obstetric care, particularly under circumstances where health centers have no access to other transport or means of communication to call for a vehicle ambulance and they are a relatively cost-effective option for the health sector. By providing on-site, designated EmOC referral transport at rural health facilities, the mAmbulances can fill a critical gap in maternal services. If implemented widely in the country, mAmbulances may also potentially help reduce cost for women and their families to access EmOC.|