Post on 20-Jun-2015
description
Fuel For LifeFuel For Life
A Model to Increase Access to Timely Emergency Obstetric Care in Uganda
The ProblemThe Problem
Every day, 800 women die from preventable pregnancy complications
Why are Mothers Dying?Why are Mothers Dying?
Delay in seeking care Delay in transportation – reaching
an adequate health facility Delay in receiving appropriate care
Three Critical Delays lead to 75% of Deaths from preventable complications
A Daily OccurrenceA Daily OccurrenceImagine you’re a midwife caring for pregnant women in labor in rural Uganda. One day, a woman comes to your clinic in labor. You identify a problem but it takes over 20 hours to coordinate reaching the hospital. By the time she arrives, the baby she carried for 9 months is dead. Each day, nearly 20 mothers in Uganda die, 41 babies dies within 1 minute of delivery, and countless stillbirths occur in similar circumstances…What can we do?
Why are Mothers Dying?Why are Mothers Dying?
1. Delay in seeking care2. Delay in transportation – reaching
an adequate health facility 3. Delay in receiving appropriate care
Three Critical Delays lead to 75% of Deaths… preventable deaths
Barriers to CareBarriers to Care
1st Delay•Perceived value2nd Delay•Communication•Cost3rd Delay•Supplies, Staffing, & Training•Advanced Notification
WHO: Reducing Maternal Deaths, 2001
Paper Transport Vouchers Increased Paper Transport Vouchers Increased Skilled Attended Deliveries Skilled Attended Deliveries
Ekirapa-Kiracho et al. BMC Intl Health Human Rights 2011
Referrals VouchersReferrals VouchersImplementation of SMGL voucher program
Saving Mothers Giving Life, unpublished data
Paper Vouchers are UnsustainablePaper Vouchers are Unsustainable
• Inefficient• Cumbersome overhead• Subject to Fraud & Abuse
THEREFORE NOT SCALABLE
Paper Vouchers are InefficientPaper Vouchers are Inefficient• Vouchers are submitted monthly to a log
maintained by program staff• Each month claims are verified
• Voucher officers visit all health centers and hospitals • Summarize data • submits funding request to finance office
• Reimbursement made (7 weeks later)
Mobile Network e-Fuel VouchersMobile Network e-Fuel VouchersFaster, Efficient & ScalableFaster, Efficient & Scalable
Fuel For LifeFuel For Life• Free Dispatch and Reimbursement
platform • Designed, Programmed, and
Developed in Uganda, by Ugandans• Strengthens and Supports Existing
infrastructure– Existing Drivers and Cars– Extensive Mobile Network
3. Patient promptly transported to hospital
4. Hospital Referral confirmed, Driver compensated
2. Driver selected; Midwife notified; clinical information captured & transmitted to Hospital
1. Midwife activates emergency alert
Grass Roots Emergency Maternal ResponseGrass Roots Emergency Maternal Response
DispatchHospital AmbulanceCommunity Drivers
1 1a
1b
Picks up Patient
23
4
Not Only EmergenciesNot Only Emergencies
• Community Vouchers Can Increase Demand • Antenatal Care• Skilled Attended Deliveries
Patient is registered at Antenatal Care
Facilitating Community to Hospital
Dispatch
4.
5.
Facilitating Community to Hospital
Dispatch
6.
1.
2. 3.
1. Laboring patient contacts local Boda driver
2. Boda driver confirms maternal voucher
3. Patient transported to health center
4. Health Center Midwife validates Boda voucher
5. Driver receives voucher for 1.5L fuel
6. Voucher redeemed
Rapid, Efficient TransportDelay #1•Emergency Transport Incentivizes Delivery at Health Centers •Bodas assist with community transport
Delay #2•Decreased Referral Time & Cost
Delay #3• Rapidly Communicates Clinical Info from Midwife to Hospital
Mobile Maternal Health Log• Facilitate M&E of Utilization and
Outcome reportingPaper Electronic data base
• Facilitates Real Time Reporting• Expedited Measurement/Evaluation• Optimized Resource Management
Future Integration: PartographFuture Integration: Partograph
• Charts progress in labor• Records fetal and maternal
condition during labor• Detects abnormal events and
patterns
Partograph Partograph Prompts Providers to Record & Respond to Critical Intrapartum Events
•Tracks changes in Fetal Heart Rate and Contractions •Tracks cervical dilation or progress in labor•Records maternal vital signs (Pulse, Blood pressure, Temperature) to improve diagnosis of problems•Records changes in amniotic fluid or maternal urine
mPartomParto
• A digitized/mobile Partograph• Centralized Patient Management• Notifications and Reminders
prompt Provider• Can identify problems early and
recommend evidence based responses
• Tracks multiple patients at the same time
• Works on Feature phones, Android and Windows Phone
Winner of the 2012 Microsoft Imagine Cup
FUEL For LIFEFUEL For LIFEA Community Led, Emergency A Community Led, Emergency
Obstetric Referral SystemObstetric Referral System
Join Us Today
Contact: Peter Klatsky M.D., M.P.H.
Department of Obstetrics & GynecologyAlbert Einstein College of Medicine, Montefiore Medical Center
Email: pklatsky@montefiore.org