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.
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.