Difficulties in securing transportation to a health facility is one of the key barriers women face when an obstetric emergency occurs. Transport can be costly especially in pregnancy when emergencies can happen far from help, without warning and at awkward times when public transportation is not available or not rapid enough.
In low and middle income countries, the participation and engagement of communities in generating funds to support the costs of health care is not a new idea. Collective sharing of risk has resulted in various financial schemes being established so that catastrophic debts are prevented when unexpected health care costs are incurred. Insurance, pre-payments, conditional cash transfers, vouchers, loans and revolving funds have been tried out, to mitigate against the problem of insufficient funds for healthcare by the poor. Some loan funds are specifically set up to meet costs associated with transport and emergency obstetric care. The loan systems make money available as a pooled community fund so that poor pregnant women and their families can use the cash to find transport and cover the costs of emergency referral.
Immpact researchers have published a new paper http://heapol.oxfordjournals.org/cgi/reprint/czu084?reviewing current evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in low and middle income countries. The study shows that where community-based loan funds were used along with other interventions, increases in utilization of health facilities for childbirth occurred. There are also indications of a potentially positive effect on women's access to care for complications and a reduction in maternal mortality. The paper was written as part of a Masters theses by Ms Chidiebere Hope Nwolise, who noted "Health inequities caused by unavailability of funds for transport during obstetric emergencies are often faced by poor pregnant women. Thus, through the creation of loan funds involving community participation and engagement, communities are empowered to solve this problem. The benefits of these community-based loan funds is not only in empowering communities, but rather extends further into empowering pregnant mothers, making obstetric care more accessible and contributing to the reduction in maternal mortality."
Transport and referral in emergency obstetric care is a key interest area of Immpact researchers. The newly published paper is part of an ongoing portfolio of research extending the knowledge base on this complex and often neglected aspect of obstetric care.