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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

Quality of 108 Basic Life Support (BLS) Ambulances in Punjab.
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pone-0109911-g003: Quality of 108 Basic Life Support (BLS) Ambulances in Punjab.

Mentions: The mean time taken to reach the facility by the user of 108 and propensity score-matched non-users was almost similar i.e. 26 minutes. Out of the 411 users, almost 90% rated ERS as ‘good’ or ‘excellent’, 6.3% as ‘average’ and 2.7% were dissatisfied with the service. Among 999 non-users, 89.4% were aware about the 108 service. Only 28 (2.8%) tried to call ERS, of whom in 10 cases call did not connect, while call could not be completed in 7 cases. In 5 cases, the call was completed but service denied, while remaining 6 did not give any reason for not availing the service. Out of the 21 ambulances assessed for infrastructure present against BLS standards, only 53% met the standards of Basic Life Support ambulance (Figure 3). Around 36% of standards for infrastructure i.e. colour of ambulance, word ‘Ambulance’ mentioned on the front and rear side, dimensions of patient's compartment etc. were met in ambulances. As against the recommended BLS guideline, about 55% consumables, 34% drugs and 77% of the equipment were available.


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)

Quality of 108 Basic Life Support (BLS) Ambulances in Punjab.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0109911-g003: Quality of 108 Basic Life Support (BLS) Ambulances in Punjab.
Mentions: The mean time taken to reach the facility by the user of 108 and propensity score-matched non-users was almost similar i.e. 26 minutes. Out of the 411 users, almost 90% rated ERS as ‘good’ or ‘excellent’, 6.3% as ‘average’ and 2.7% were dissatisfied with the service. Among 999 non-users, 89.4% were aware about the 108 service. Only 28 (2.8%) tried to call ERS, of whom in 10 cases call did not connect, while call could not be completed in 7 cases. In 5 cases, the call was completed but service denied, while remaining 6 did not give any reason for not availing the service. Out of the 21 ambulances assessed for infrastructure present against BLS standards, only 53% met the standards of Basic Life Support ambulance (Figure 3). Around 36% of standards for infrastructure i.e. colour of ambulance, word ‘Ambulance’ mentioned on the front and rear side, dimensions of patient's compartment etc. were met in ambulances. As against the recommended BLS guideline, about 55% consumables, 34% drugs and 77% of the equipment were available.

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