It is increasingly accepted in our understanding of maternal healthcare in Africa that poor physical access is reducing the effectiveness of measures to reduce maternal mortality. This project developed an evaluation framework that combined transport measures with health condition assessment methods of the Vital Signs approach and the Glasgow Coma Score to assess differences in patient condition when being referred from local health centres to higher-level referral facilities. Surveys were undertaken of 704 women from 40 communities across Katsina State, Northern Nigeria. It was found that whilst the majority took 1-2 hours between being referred and arriving at the referral facility many took up-to 7 hours. Whilst using the Glasgow Coma Score, the study found no statistical relationship between health condition and how a patient arrived at the referral facility or how long it took to arrive. However, using the Vital Signs approach, statistical associations were found between a number of vital signs and how women arrived at the referral facility and how long it took to be referred. As a result, improvements to how women travel to referral facility and the time referral takes can have positive impacts on the severity of patients managed by referral facilities. Efforts by a range of countries across West Africa to establish widespread ambulance provision may be effective in contributing to reducing maternal mortality. This study shows they may have a positive impact on the skills, resources and equipment emergency obstetric care facilities needed to reduce maternal mortality.
TRANSAID. Linking Rural Communities with Health Services:Assessing the Effectiveness of the Ambulance Services in Meeting the Needs of Rural Communities in West Africa. Final Report. (2013) 185 pp.