Increasing facility-based deliveries and providing referral transport for women in childbirth in Asia

Helpdesk Query:

Produce a report on approaches to:

i) increasing the proportion of deliveries which take place in health facilities; and

ii) providing referral transportation for women and children to access healthcare for childbirth and for emergency obstetric care.

The focus is on Asia and particularly South East Asia.

Summary:

Approaches to increasing facility based births:

  • Eliminating user fees and voucher schemes have been found to improve facility-based delivery rates.
  • A systems approach was found to increase facility-based deliveries in the Philippines. The strategy prioritised the creation of community-based women’s health teams. Payment to a trained birth assistant within a health team incentivised referral to a health facility.
  • Evaluations of an Indian state-led public private partnership where the state pays accredited private obstetricians to perform deliveries for poor/tribal women produced mixed results.
  • Maternity waiting homes are included as an option in the safe motherhood programme and recommended by experts. However, little evidence was found to support the use of maternity waiting homes.
  • A behaviour change communication initiative in Bangladesh was estimated to increase the likelihood of mothers having institutional deliveries.

 

Referral transport findings:

  • A systematic review found some evidence to suggest that community-based loan funds for transport during obstetric emergencies in developing countries have positive effects.
  • A CARE Village Emergency Referral System in Cambodia reports some anecdotal success and some issues.
  • An emergency obstetric transportation service in Madhya Pradesh, India, was successful as part of a public private partnership. A publicly financed and managed referral transport service model in Haryana State, India, was assessed for cost effectiveness and found to be operating at an efficient level.

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