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Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

Prinja S, Bahuguna P, Lakshmi PV, Mokashi T, Aggarwal AK, Kaur M, Reddy KR, Kumar R - PLoS ONE (2014)

Bottom Line: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries.Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent.The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Background: Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost.

Methods: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective.

Results: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled.

Conclusion: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

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Related in: MedlinePlus

Actual trend and predicted trends of month-wise number of deliveries in public institution in Punjab, April 2008-June 2013.
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pone-0109911-g001: Actual trend and predicted trends of month-wise number of deliveries in public institution in Punjab, April 2008-June 2013.

Mentions: The data series was adjusted for first order autocorrelation and seasonality. After adjustment for autocorrelation, we found no effect of ERS on institutional delivery. This reflects that the increase in institutional deliveries as a result of other interventions in the pre-intervention period could have had a secular trend which was showing an increase in institutional deliveries in the unadjusted model. (Table 4 and Figure 1).


Evaluation of publicly financed and privately delivered model of emergency referral services for maternal and child health care in India.

Prinja S, Bahuguna P, Lakshmi PV, Mokashi T, Aggarwal AK, Kaur M, Reddy KR, Kumar R - PLoS ONE (2014)

Actual trend and predicted trends of month-wise number of deliveries in public institution in Punjab, April 2008-June 2013.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215978&req=5

pone-0109911-g001: Actual trend and predicted trends of month-wise number of deliveries in public institution in Punjab, April 2008-June 2013.
Mentions: The data series was adjusted for first order autocorrelation and seasonality. After adjustment for autocorrelation, we found no effect of ERS on institutional delivery. This reflects that the increase in institutional deliveries as a result of other interventions in the pre-intervention period could have had a secular trend which was showing an increase in institutional deliveries in the unadjusted model. (Table 4 and Figure 1).

Bottom Line: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries.Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent.The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Background: Emergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost.

Methods: Data for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective.

Results: On an average, an ambulance transported 3-4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled.

Conclusion: Emergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

Show MeSH
Related in: MedlinePlus