Project Lead(s): Nazmul Alam
Issue
About 800 women die every day due to complications arising following pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries.
Delay in transporting pregnant women for emergency obstetrical-care services is an avoidable factor for reducing maternal mortality but alleviating these problems is a relatively neglected issue.
Traditional car ambulances seem to be an obvious solution but such ambulances are mostly unavailable, costly (in terms of purchase, fuel, maintenance and repair) and are usually stationed at the referral hospital level and not in remote rural areas where they are needed the most.
Solution
Implemented in Bangladesh, this project tested the feasibility of using a motorized three wheeler van (Mom’s Van) as an ambulance for priority transportation of pregnant women in rural areas for emergency obstetrical care.
Each van has a dedicated cell phone for networking and is managed by the community with adoption of a limited income-generation plan for sustainability.
The primary objective of the project was to determine acceptability and feasibility of the ‘Mom’s Van’ intervention.
In the formative research stage, information was collected through surveys, in-depth interviews, focus group discussions and direct observation, to gain baseline information and to get feedback for designing interventions.
The project then deployed three motor ambulances in three rural areas in the Mymensingh district of Bangladesh, to cover a population of approximately 100,000. The project was piloted at Nagpur, Atarampur and Khelar Algi community clinics.
Outcome
This pilot project demonstrated the feasibility and acceptability of ‘Mom’s Van’ as an ambulance to transport pregnant mothers to hospitals in Bangladesh, to improve maternal health outcomes.
The three ambulances transported 184 patients to the study clinics. These transfers permitted patients to receive appropriate healthcare more quickly, often in a context of emergency.
Of the 184 transfers, 77 were for patients seeking maternal or neonatal healthcare, while the remaining transfers were done for other health reasons (such as road accidents, infections, cardiac problems and poisonings).
As a result of this pilot project, 65 children who would have been born at home were delivered in health facilities.
Due to a lack of emergency transport, ‘Mom’s Van’ is taking care of a broader population than anticipated, especially for the Nagpur Community clinic.
This pilot project has created enormous enthusiasm in the community and the health administration in Bangladesh.
The lessons learned from implementation of the intervention have been documented for adaptation in the scale-up project. The project team is planning to apply for scale-up funding from Grand Challenges Canada to develop a pragmatic community randomized controlled trial for evaluation of the ‘Mom’s Van’ intervention.