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A free, reliable method of transportation to and from health facilities may soon be available to women in Uttar Pradesh, India. The government of Uttar Pradesh is working to provide rides for women from their homes to health facilities for childbirth, and back again once they have recovered, by scaling up a pilot program called PPS (or Prasav Parivahan Seva).
Far too many pregnant women and new mothers in Uttar Pradesh are hindered by transportation costs when it comes to getting the health care they and their newborns need. That’s why the IntraHealth International-led Manthan Project spearheaded PPS, a nine-month pilot program based on public-private partnership in Uttar Pradesh’s Jhansi district.
Over the course of the pilot, IntraHealth found that not only can emergency transport be successfully integrated into Uttar Pradesh’s health care system, but it can also improve care for women and newborns.
According to a survey before the pilot, the median stay for women who had just delivered babies at health facilities in Jhansi district was about three hours—far below the 48 hours recommended by the Government of India. Those hours are critical for moms and babies, a time when dangerous complications such as post-partum hemorrhage, sepsis, and newborn asphyxia can occur.
It turned out that transportation was a key factor in the mothers’ short stays.
The cost of hiring cars to reach the health facility and later to return home is simply unaffordable, many families said. In fact, only 57% of women who arrived in labor used motorized vehicles to reach the facilities. And many returned home with their just-delivered newborns by the same vehicles they had hired to reach the facility.
Those families knew that the less time mothers spent recovering and receiving postnatal care, the less they’d be charged by the drivers waiting outside.
As part of the pilot, IntraHealth contracted a local private agency to run four vehicles, which were on call 24 hours a day and stationed at primary health centers. They also established a 24-hour call center at the district hospital to coordinate the vehicles.
When a call came in from a family member or from an ASHA (that is, an accredited social health activist, a type of community health worker in India), call center staff would contact an available driver with instructions, and then alert the health facility that a client was on her way.
PPS also provided transportation when complications arose and women were referred to larger facilities.
Over the course of nine months, PPS vehicles made 3,967 trips and served 2,376 clients. More than three quarters of users were from small, remote hamlets. And PPS benefitted women from poorer families the most.
IntraHealth also found that having a reliable ride home encouraged women to stay longer after their deliveries. About 86% of women who used PPS stayed in the health facility with their newborns for six hours or more, an improvement over the three-hour median length of stay before PPS.
Overall, IntraHealth found, a model of public-private partnership is an effective option for integrating emergency transport into Uttar Pradesh’s health care system. Demonstrating the viability of this option was a vital first step in helping the government to move forward with its own emergency transport system.
But IntraHealth found that not even PPS’s services were enough to encourage most women to stay for the recommended 48 hours. Transportation, it turns out, is not the only reason many women hasten to return home after their deliveries.
Another reason is that many mothers, families, and health workers in the district don’t fully understand the importance of postnatal care. Also, according to survey respondents, the lack of adequate beds, water, toilets, security, and electricity are major influencing factors as well.
India has some of the highest rates of maternal and neonatal deaths in the world. And nearly 30% occur in Uttar Pradesh, the country’s most populous state. Greater access to skilled health workers—and to well managed facilities that have the resources and infrastructure they need—can greatly reduce those numbers. PPS is just one step in the right direction for the government of Uttar Pradesh.
And it’s an affordable one. Project staff calculated the average total cost per one-way trip during the pilot was about 450 rupees, or $7.51.
With a few tweaks, such as establishing a state-level call center that serves multiple districts, the cost to the government could be even lower—and the benefits to Uttar Pradesh’s mothers and babies incalculable.
IntraHealth partnered with the Jhansi district administration and the government of Uttar Pradesh’s Department of Medical, Health, and Family Welfare to conduct the PPS pilot program in Uttar Pradesh’s Jhansi district from July 2011 through March 2012. The Manthan Project was funded by the Bill & Melinda Gates Foundation.
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