Business models of public private partnerships in publicly-financed emergency response services

Sundararaman, T; Nair, Arun; Mokashi, Tushar; Chakraborthy, Gautam

doi:10.1186/1753-6561-6-s5-p8

Cited by 3 publications

(7 citation statements)

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“…A PPP framework could be the best way forward for policy makers. For example, integrating hospital referral transport services as has been done in the Haryana Swasthya Vahan Sewa (HSVS) model and or local patient transport tie-ups as in the Janani Express (JE) model could be an option to provide emergency referral services for pregnant women at very affordable cost and to establish a much larger range of patient transport services without adversely affecting GVK EMRI services (37,40,41). Each of these referral transport services has its positive points as well as drawbacks.…”

Section: Way Forward For Creating Better Public Referral Transport Sementioning

confidence: 99%

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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Background: An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). Methods: A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. Results: It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. Conclusion:The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.

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Section: Way Forward For Creating Better Public Referral Transport Sementioning

confidence: 99%

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Raj

Manthri

Sahoo

2015

Int J Health Policy Manag

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“…Studies have also shown that higher proportions of women who use publically financed transportation schemes (‘108’/‘102’/Janani Express yojana) belong to historically disadvantaged and backward social caste, below the poverty line, are less educated and mostly from rural geographical areas compared with non-users. 21 35–38 …”

Section: Discussionmentioning

confidence: 99%

“…The ‘108’ ambulances are stationed close to CHCs and should be readily available, but if the ambulance is on route for pick-up or drop-off of another client then the IFT client with complications will have to wait or arrange for another means of transportation. 21 The ‘108’ service may consider prioritising IFTs by having dedicated fleet of ambulances for IFTs over transporting all non-IFTs by increasing the fleet of ambulances stationed closer to beneficiaries. 25 In some states, the underused ambulances at the health facilities are being used through the ‘102’ call centre along with ‘108’; however, the distribution of these into IFT and non-IFT use has not been well laid out.…”

Section: Discussionmentioning

confidence: 99%

“…25 In some states, the underused ambulances at the health facilities are being used through the ‘102’ call centre along with ‘108’; however, the distribution of these into IFT and non-IFT use has not been well laid out. 21 In other states, ‘102’ has new ambulances that focus on IFT or transfers back to home for pregnant women. 26 Since 2013, state of Assam has a dedicated fleet of 450 ambulances for IFTs operating through the ‘102’ call system.…”

Section: Discussionmentioning

confidence: 99%

“…These may also provide transport between facilities. 21 25 26 For example, Janani Express yojana (public private non-ambulance transport service), operating through call centres within districts, transfers exclusively pregnant women and newborns in Madhya Pradesh and Odisha. 21 25 In larger cities, some other ambulance services (free or paid) are also available.…”

Section: Introductionmentioning

confidence: 99%

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Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

et al. 2017

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ObjectiveTo estimate the proportion of interfacility transfers (IFTs) transported by ‘108’ ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of ‘108’ services for pregnant women in India.DesignA cross-sectional analysis of ‘108’ ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called ‘108’.Main outcomesProportion of all pregnancies and institutional deliveries in the population who were transported by ‘108’, both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT.ResultsThe ‘108’ ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that ‘108’ transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by ‘108’ for IFTs—lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all ‘108’ IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states.ConclusionOnly 6% institutional deliveries made use of the ‘108’ ambulance for IFTs in India. The vast majority did not have any complication or emergency. The ‘108’ service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT.

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Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

et al. 2014

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BackgroundEmergency referral services (ERS) are being strengthened in India to improve access for institutional delivery. We evaluated a publicly financed and privately delivered model of ERS in Punjab state, India, to assess its extent and pattern of utilization, impact on institutional delivery, quality and unit cost.MethodsData for almost 0.4 million calls received from April 2012 to March 2013 was analysed to assess the extent and pattern of utilization. Segmented linear regression was used to analyse month-wise data on number of institutional deliveries in public sector health facilities from 2008 to 2013. We inspected ambulances in 2 districts against the Basic Life Support (BLS) standards. Timeliness of ERS was assessed for determining quality. Finally, we computed economic cost of implementing ERS from a health system perspective.ResultsOn an average, an ambulance transported 3–4 patients per day. Poor and those farther away from the health facility had a higher likelihood of using the ambulance. Although the ERS had an abrupt positive effect on increasing the institutional deliveries in the unadjusted model, there was no effect on institutional delivery after adjustment for autocorrelation. Cost of operating the ambulance service was INR 1361 (USD 22.7) per patient transported or INR 21 (USD 0.35) per km travelled.ConclusionEmergency referral services in Punjab did not result in a significant change in public sector institutional deliveries. This could be due to high baseline coverage of institutional delivery and low barriers to physical access. Choice of interventions for reduction in Maternal Mortality Ratio (MMR) should be context-specific to have high value for resources spent. The ERS in Punjab needs improvement in terms of quality and reduction of cost to health system.

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Business models of public private partnerships in publicly-financed emergency response services

Cited by 3 publications

References 0 publications

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Emergency referral transport for maternal complication: lessons from the community based maternal death audits in Unnao district, Uttar Pradesh, India

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

Evaluation of Publicly Financed and Privately Delivered Model of Emergency Referral Services for Maternal and Child Health Care in India

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