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. 2021 Mar 15;9(Suppl 1):S122-S136.
doi: 10.9745/GHSP-D-20-00511. Print 2021 Mar 15.

Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique

Felizarda Amosse  1 , Helena Boene  1 , Mai-Lei Woo Kinshella  2 , Sharla Drebit  2 , Sumedha Sharma  2 , Prestige Tatenda Makanga  3 , Anifa Valá  1 , Laura A Magee  4 , Peter von Dadelszen  4 , Marianne Vidler  2 , Esperança Sevene  1   5 , Khátia Munguambe  6   5 ; Community Level Interventions for Pre-eclampsia (CLIP) Working Group
Affiliations

Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique

Felizarda Amosse et al. Glob Health Sci Pract. .

Abstract

Introduction: Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique.

Methods: From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database.

Results: Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women.

Conclusion: These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems.

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Figures

FIGURE 1
FIGURE 1
Map Showing Study Areas Where Community Transport Program to Improve Access to Emergency Obstetric Case Was Implemented, Southern Mozambique
FIGURE 2
FIGURE 2
Process of Preparing and Implementing the Community Transport Program to Improve Access to Emergency Obstetric Care, Southern Mozambique
FIGURE 3
FIGURE 3
Number of Individuals Transported in the Community Transport Program by Target Group, Southern Mozambique (N=20)
FIGURE 4
FIGURE 4
Number of Individuals Who Requested Community Transport by Condition That Triggered Request, Southern Mozambique (N=20)
See this image and copyright information in PMC

References

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