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.