Percent of communities that have an emergency transport plan in place
The percent of communities in a designated area that have made an explicit plan to provide emergency transport for pregnant women who require care at a basic or comprehensive emergency obstetric care (EmOC) facility. For further background on basic and comprehensive EmOC, see WHO et al. (2010).
Communities can be defined as towns, villages, rural locales, and urban districts and neighborhoods that are functionally identified as communities.
Emergency transport plans should identify, at a minimum, the means of transportation, driver(s), payment scheme, and nearest EmOC.
This indicator is calculated as:
(Number of communities with an emergency transport plan / Total number of communities in a designated area ) x 100
Using maps or listings of communities by designated districts, the data for this indicator can be collected through specialized surveys and/or interviews with key informants from the communities and the respective destination EmOC facilities. The data can be disaggregated by the type of community (e.g., urban/ small city/ town/ rural), modes of transportation designated in plan, and types of facilities accessed by the community (e.g., basic versus comprehensive EmOC and/or public, private, non-governmental, community based).
Listings of or maps identifying rural and urban communities; specialized surveys; interviews with key informants
This indicator measures access to EmOC services based on the capacity of communities to plan for providing women with timely and suitable emergency transportation. Simply having EmOC facilities within the recommended travel distance is not enough. Women in need of emergency care must have a means to get there. The details and working components of community emergency transport plans will vary greatly by the types of settings and transportation available and the distances to nearest facilities. In Northern Nigeria, select National Union of Road Transport Workers (NURTW) car drivers participated in an emergency transport scheme. They were trained by NURTW trainers on the safe motherhood situation, the need to respond quickly to maternal emergencies, how to carry a pregnant woman, where to take them, and the need to keep a supply of gasoline within the community at all times. Families using these drivers paid a fixed amount to be transported to the health facility, and could pay in arrears if necessary. Drivers were given identification cards to ensure that they were not held up by police at road-blocks, and to facilitate their access once at the health facility (DFID, 2008).
In urban neighborhoods, women may need transportation by capably driven vehicles that can contend with congested traffic, such as emergency ambulances or vehicles with sirens. In rural communities, distances to the closest facilities may be long and vehicles are needed that can make the journey safely and efficiently. In settings with rugged terrain, traveling even relatively short distances may take a very long time if done on foot, horseback or by donkey cart, and appropriate transport is needed to help women negotiate the difficult journey.
The goal is for all women to be within two hours of a basic EmOC facility and within twelve hours of a comprehensive EmOC that can also provide surgery and blood transfusions. The two-hour time frame was selected as a maximum limit because hemorrhage, the most rapidly fatal complication of pregnancy, can kill a mother in two hours (UNFPA, 2004). Communities with effective plans in place to help women get to the closest facilities as quickly and safely as possible can help save the lives of women and their infants. This indicator depicts the current status of community emergency transport plans, can show trends over time, and can be used for planning and advocacy at national, district, and community levels. This measure of women’s access to EmOC services relates to achieving Millennium Development Goals #5. improve maternal health #4. reduce child mortality.
While the indicator accounts for communities having made emergency transportation plans, it does not capture the feasibility of the plans, whether the plans are being implemented, or whether the plans are successful in transporting women to EmOC facilities in a timely and safe fashion.
postabortion care, emergency, obstetric fistula (OF), health system strengthening (HSS), safe motherhood (SM), access
UNFPA, 2004, Program Manager’s Planning Monitoring and Evaluation Toolkit, Part II: Indicators for Reducing Maternal Mortality, New York: UNFPA. http://www.unfpa.org/monitoring/toolkit/Tool6_2.pdf
WHO, UNFPA, UNICEF, AMDD, 2010, Monitoring Emergency Obstetric Care: A handbook, Geneva: WHO. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf
DFID, 2008, PATHS Technical Brief: Increasing Access to Safe Motherhood Services. http://resources.healthpartners-int.co.uk/wp-content/uploads/2015/05/Increasing-access-to-safe-motherhood_PATHS1_2008.pdf