Did Saving Mothers, Giving Life Expand Timely Access to Lifesaving Care in Uganda? A Spatial District-Level Analysis of Travel Time to Emergency Obstetric and Newborn Care.

Michelle M Schmitz,Florina Serbanescu,Marc Cunningham,Patrick Komakech,Vincent Kamara,Joan Marie Kraft,Mary M Goodwin,Claudia Morrissey Conlon,Gregory Opio

doi:10.9745/ghsp-d-18-00366

Abstract

Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC). Spatial travel-time analyses provide a visualization of changes in timely access. We compared travel-time estimates to EmONC health facilities in SMGL-supported districts in western Uganda in 2012, 2013, and 2016. To examine EmONC access, we analyzed a categorical variable of travel-time duration in 30-minute increments. Data sources included health facility assessments, geographic coordinates of EmONC facilities, geolocated population estimates of women of reproductive age (WRA), and other road network and geographic sources. The number of EmONC facilities almost tripled between 2012 and 2016, increasing geographic access to EmONC. Estimated travel time to EmONC facilities declined significantly during the 5-year period. The proportion of WRA able to access any EmONC and comprehensive EmONC (CEmONC) facility within 2 hours by motorcycle increased by 18% (from 61.3% to 72.1%, P < .01) and 37% (from 51.1% to 69.8%, P < .01), respectively from baseline to 2016. Similar increases occurred among WRA accessing EmONC and CEmONC respectively if 4-wheeled vehicles (14% and 31% increase, P < .01) could be used. Increases in timely access were also substantial for nonmotorized transportation such as walking and/or bicycling. Largely due to the SMGL-supported expansion of EmONC capability, timely access to EmONC significantly improved. Our analysis developed a geographic outline of facility accessibility using multiple types of transportation. Spatial travel-time analyses, along with other EmONC indicators, can be used by planners and policy makers to estimate need and target underserved populations to achieve further gains in EmONC accessibility. In addition to increasing the number and geographic distribution of EmONC facilities, complementary efforts to make motorized transportation available are necessary to achieve meaningful increases in EmONC access.

Highlights

Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC)
We examine whether geographic access improved during SMGL implementation and identify areas where access issues persisted at the conclusion of the project
To assess whether districts met the World Health Organization (WHO) benchmark of EmONC availability, we followed the WHO guidelines, which recommend a minimum of 5 EmONC facilities per 500,000 population, including at least 1 comprehensive emergency obstetric and newborn care (CEmONC) facility in each district.[37]

Summary

Introduction

Interventions for the Saving Mothers, Giving Life (SMGL) initiative aimed to ensure all pregnant women in SMGL-supported districts have timely access to emergency obstetric and newborn care (EmONC). Did the Saving Mothers, Giving Life Initiative Expand Timely Access?. Www.ghspjournal.org birth and estimated that 50% to 70% of maternal deaths could be averted with timely access to emergency obstetric interventions.[5,6] access to quality services in low-resource countries continues to be a challenge, especially for women and newborns who require emergency obstetric and newborn care (EmONC). Physical distance to health care facilities has been widely recognized as an important determinant of accessing health facility delivery.[7,8,9,10]

Methods

Results

Discussion

Conclusion