Cost Effectiveness of Ambulance Referral Services on Maternal Health Outcome Perspective from Southern Asia
Abstract
Maternal and neonatal mortality remain an unsolved health priority in low income countries and sub-Saharan Africa in particular. Most maternal deaths are actually preventable and occur during labour, delivery and the first day postpartum. Skilled attendance at birth is the most important intervention to reduce maternal and neonatal mortality since complications leading to these deaths are unpredictable but can be successfully treated if diagnosed early and properly managed Maternal and neonatal mortality remain an unsolved health priority in low income countries and Southern Asia in particular. The Millennium Development goal of reducing child mortality by 2015 was not achieved by many South Asian countries where 60% of the deaths are infants. Delivery is a critical moment for both the mother and the child and each year an astonishing two million neonatal deaths are attributed to complications during birth and this burden is mainly carried by developing countries. In low-income countries almost half of fetal deaths happen during or around delivery time and approximately three quarters of neonatal deaths occur within the first days after birth. It is estimated that most maternal deaths are actually preventable and occur during labour, delivery and the first day postpartum. In India, considerable attention has been paid to estimates of maternal mortality, but mere has been reserved to the issue of adolescents pregnancies requires paramount attention. Despite substantial improvement in maternal health indicators in India, the proportion of adolescent deaths (9%) due to pregnancy or during child birth to total maternal mortality is unacceptably high. The study sought to assess the cost-effectiveness of ambulance referral services on maternal health outcome in Rural India. This study was a retrospective cross-sectional cost-effectiveness analysis of ambulance referral services in Rural India using a healthcare system perspective of parturient women transferred by ambulance to a higher level hospital compared with self-referrals 2010 and 2019. The data for the study was obtained from ambulance emergency referral network unit/services, health facilities maternal registers and patient files, KII with the health management of the Counties. The study found reduction in neonatal deaths in four South Asian RCTs of community mobilization interventions, which included the generation of funds for transport, to overcome phase II delays. It was not possible to disentangle the effects of the phase II intervention with other components that addressed other types of delays or that improved care. The study concluded that initiatives to improve the transportation system for the referral of obstetric emergencies are vital in ensuring patients’ safety during transfer. Communication between referring and receiving facilities should be enhanced. A strong collaboration is needed between teaching hospitals and other stakeholders in the referral chain to foster good referral practices and healthcare delivery. Based on the findings the study recommends that it should be possible to reduce maternal deaths (and the deaths of babies during pregnancy, childbirth, and early life) in developing countries by ensuring that pregnant women are referred to emergency obstetric services quickly when the need arises.
Keywords: Cost Effectiveness, Ambulance Referral Services, Maternal Health, Outcome, Southern Asia.
References
Abdollahpour, S., Heidarian Miri, H., Khademol Khamse, F., & Khadivzadeh, T. (2020). The relationship between global gender equality with maternal and neonatal health indicators: an ecological study. The Journal of Maternal-Fetal & Neonatal Medicine, 1-7.
Achanna, S., Krishnaswamy, G., Ponnampalam, P., & Chattopadhyay, A. B. (2018). Maternal Mortality in Malaysia. Medical Research Archives, 6(2).
Ahmed, I., Ali, S. M., Amenga-Etego, S., Ariff, S., Bahl, R., Baqui, A. H.,. & Zaidi, A. (2018). Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. The Lancet Global Health, 6(12), e1297-e1308.
Altintas, K. H., Bilir, N., & Tüleylioglu, M. (1999). Costing of an ambulance system in a developing country, Turkey: costs of Ankara Emergency Aid and Rescue Services'(EARS) ambulance system. European Journal of Emergency Medicine, 6(4), 355-362.
Bahuguna, P., Guinness, L., Sharma, S., Chauhan, A. S., Downey, L., & Prinja, S. (2020). Estimating the unit costs of healthcare service delivery in India: addressing information gaps for price setting and health technology assessment. Applied health economics and health policy, 1-13.
Bordens, K. S., & Abbott, B. B. (2008). Research methods and design: A process approach.
Creswell, J. W. (2014). A concise introduction to mixed methods research. SAGE publications.
Davis, N. L., Smoots, A. N., & Goodman, D. A. (2019). Pregnancy-Related Deaths: Data from 14 US Maternal Mortality Review Committees. Education, 40(36), 8-2.
Ditai, J., Nakyazze, M., Namutebi, D. A., Auma, P., Chebet, M., Nalumansi, C., & Weeks, A. D. (2020). Maternal and newborn health priority setting partnership in rural Malaysia in association with the James Lind Alliance: a study protocol. Research involvement and engagement, 6(1), 1-16.
Geleto, A., Chojenta, C., Musa, A., & Loxton, D. (2018). Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature. Systematic reviews, 7(1), 183.
Kuruvilla, S., Schweitzer, J., Bishai, D., Chowdhury, S., Caramani, D., Frost, L., & Bustreo, F. (2014). Success factors for reducing maternal and child mortality. Bulletin of the World Health Organization, 92, 533-544.
Nair, M., Nelson-Piercy, C., & Knight, M. (2017). Indirect maternal deaths: UK and global perspectives. Obstetric medicine, 10(1), 10-15.
Paul, P., & Chouhan, P. (2020). Socio-demographic factors influencing utilization of maternal health care services in India. Clinical Epidemiology and Global Health, 8(3), 666-670.
Prinja, S., Manchanda, N., Aggarwal, A. K., Kaur, M., Jeet, G., & Kumar, R. (2018). Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India. The Indian journal of medical research, 138(6), 1003.
Van Barneveld, T. C., Bhulai, S., & van der Mei, R. D. (2016). The effect of ambulance relocations on the performance of ambulance service providers. European Journal of Operational Research, 252(1), 257-269.
World Health Organization. (2018). WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections. World Health Organization.