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Maternal and Child Health MDG’s & Transport in Africa: the need for a research focusJeff TurnerProgramme ManagerAfrica Community Access Programme (AFCAP)jeff.turner@afcap.orgwww.afcap.orgPresentation to the IFRTD ’Bridging the gap: addressing mobility needs as a means to achieve the health-related MDG’s’ side event at UN-CSD-18, New-York, 3rd May, 20010

a space for action
A space for action
  • Within the policy discussion on maternal mortality there is a need for:
    • more accurate measurement,
    • more focused solutions,
    • more sensitive social scientific analysis of the relationship between mobility, gender and health.
  • There is now a policy goal of dramatically reducing maternal mortality in Africa and there is a body of evidence which speaks to the scale of the problem
  • However, the literature on concrete measures for bringing about this goal and the operational activities of development agencies in pursuit of this goal are thin on the ground.
  • Particularly in respect of the transport and the maternal/neo-natal mortality link.
what is afcap
What is AFCAP?
  • AFCAP promotes improved rural physical access in sub-Saharan Africa by identifying the evidence for good policy and practices; communicating and encouraging the uptake of that evidence; and promoting knowledge sharing within the community of practice.
  • AFCAP is a 5-year programme funded by the UK government, with a budget of £7.5 million with same amount contributed by partner governments
  • AFCAP implementation started in June 2008
  • AFCAP develops research collaboration between targeted African countries (currently Mozambique, Malawi, Tanzania, Kenya, Ethiopia)
  • Supports partnership of Aga Khan University, Kenya, IFRTD and University of Leeds, UK to review existing literature on maternal & neo-natal health and transport
afcap review of maternal neo natal health transport
AFCAP – Review of Maternal & Neo-natal Health & Transport

Fawcus S, Mbizvo M, Lindmark G, Nyström L. A community-based investigation of avoidable factors for maternal mortality in Zimbabwe. Studies in Family Planning. 1996 Nov-Dec;27(6):319-27.

  • Lack of transportation delayed or prevented access to healthy facilities in the rural area, a major problem in 28 percent of the maternal mortality cases studied.

Walraven, G; Telfer, M; Rowley, J; Ronsmans, C. Maternal mortality in rural Gambia: levels, causes and contributing factors. BULLETIN OF THE WORLD HEALTH ORGANIZATION 78 (5):603-613 2000

  • A total of 9 of the 18 deaths recorded using verbal autopsy had indirect causes of obstetric deaths indentified as anemia (4 deaths), hepatitis (1), and undetermined (4). The following were identified more than once mentioned as probable or possible contributing factor to these maternal deaths:
    • Low standards of health care for obstetric referrals,
    • failure to recognize the severity of the problem at the community level,
    • delays in starting the decision-making process to seek health care,
    • lack of transport and
    • substandard primary health care
afcap review of maternal neo natal health transport1
AFCAP – Review of Maternal & Neo-natal Health & Transport

Gil-González, Carrasco-Portiñoa & RuizKnowledge gaps in scientific literature on maternal mortality: a systematic review, Bulletin of the World Health Organization, November 2006, 84 (11)

  • Found that distance and transport constraints were analysed in 41% of studies discovered in a systematic review though on 11% had designed for this issues
afcap review of maternal neo natal health transport2
AFCAP – Review of Maternal & Neo-natal Health & Transport

Cisse, C T; Faye, E O; de Bernis, L; Dujardin, B; Diadhiou, F. [Cesarean sections in Senegal: coverage of needs and quality of services]. Sante 8 (5):369-77 1998

  • Unsuitable transport means to hospital
    • 41% were transported to the hospital in ambulances,
    • 14% in private cars, and
    • 44% by public transportation
  • 6.7% of the women had to be re-evacuated from supposedly ultimate referral hospitals due to lack of supplies or personnel.
afcap review of maternal neo natal health transport3
AFCAP – Review of Maternal & Neo-natal Health & Transport

Akello B, Nabiwemba E, Zirabamuzaale C, Orach CG. Risk factors for perinatal mortality in Arua regional referral hospital, West Nile, Uganda. East Afr J Public Health. 2008 Dec;5(3):180-5.

  • Modelling found that significant risk factors for perinatal deaths included:
    • living more than 5 kilometres from the hospital
    • transport problem
    • baby not being resuscitated and
    • baby being born with low Apgar score

Lee AC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, Wall SN, Nandakumar AK, Syed U, Darmstadt GL. Linking families and facilities for care at birth: What works to avert intrapartum-related deaths? Int J Gynaecol Obstet. 2009 Aug.

  • Present a systematic review of strategies to link families and facilities, including community mobilization, financial incentives, emergency referral and transport systems, prenatal risk screening, and maternity waiting homes.
  • Found evidence is limited, but promising, that financial incentive schemes and community referral/transport systems may increase rates of skilled birth attendance and emergency obstetric care utilization; however, impact on mortality is unknown.
  • The effect of all of these strategies on maternal and perinatal mortality, particularly intrapartum-related outcomes, requires further evaluation.
interaction between rural access and health mdg s
Interaction between rural access and health MDG’s

AFCAP is supporting the development of a research consortium on the interaction between rural community access and the MDG on maternal mortality

This is bringing together a multi-disciplinary research team from:

across 6 African countries.

Across health and transport specialist areas

Across researchers and ministries responsible for implementation

interaction between rural access and health mdg s1
Interaction between rural access and health MDG’s

Research will seek to use a series of case studies to evaluate on a comparable basis the impact of different access interventions on maternal and neo-natal health outcomes

Interventions could include

Community-based transport provision

Improved communications

Community financing for transport

Maternity waiting homes

If you are engaged in trying to address issues of rural access to healthcare in current or planned projects we would be interested in exploring linkages