Implementation of a community-based referral project to improve access to emergency obstetric and newborn care in Rohingya population during COVID-19 pandemic in Bangladesh

Abstract

IntroductionThe delay in seeking emergency obstetric care leads to significant maternal morbidity and mortality and can worsen during pandemics, especially in humanitarian conflict settings with low uptake of obstetric services. To mitigate the challenges related to the second delay caused by lack of transport in the COVID-19 pandemic, the organisation United Nations Population Fund implements a community-based referral project called Referral Hub in the Rohingya refugee population in Bangladesh. The objective of the paper is to describe the implementation process of the Referral hub and present clients’ utilisation and perception of the service.MethodsFindings from part of a larger mixed-method study, the analysis of the standard operating protocol of the intervention, secondary data of routine utilisation of the 12 referral hubs between January and August 2020, 21 key informant interviews and a community survey among 100 pregnant women are presented in this paper.ResultsThe findings show an increasing trend in the referral hub utilisation and a strong recommendation of the service.ConclusionDue to a robust referral mechanism by collaborating with the community and engaging accessible and free of cost transport service, the intervention has high potential to improve access to facility care in low-resource and humanitarian contexts, especially during pandemics.

Interventions to maintain essential services for maternal, newborn, child, and adolescent health during the COVID-19 pandemic: A scoping review of evidence from low- and middle-income countries

“…The most represented region was Africa (34%), with three studies being conducted in Zambia [ 12 – 14 ], three in Zimbabwe [ 15 – 17 ], two in Nigeria [ 15 , 18 ], and one in Cameroon [ 19 ], Kenya [ 15 ], and South Africa [ 20 ] each. Further, 31% of the interventions were carried out in Southeast Asia, including six in India [ 21 - 26 ], two in Indonesia [ 27 , 28 ], and one in Thailand [ 29 ] and Bangladesh [ 30 ] each. Five interventions were conducted in the Eastern Mediterranean (16%), and one each in Iran [ 31 ], Jordan [ 32 ], Lebanon [ 33 ], Pakistan [ 34 ], and Somalia [ 35 ].…”

“…Reflecting on the summary of the lessons learned on recurrent themes, several of the included studies highlighted the way the COVID-19 pandemic exacerbated existing health problems due to issues related to socioeconomic barriers such as the fragility of given contexts (e.g. a refugee camp [ 30 ]), socio-economic barriers to seeking care [ 20 ], or due to unavailability of health services for certain populations (e.g. adolescent girls [ 14 ]).…”

Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

“…Women in the current study experienced similar barriers as they sought EMOC. In Bangladesh, women needing emergency obstetric care services needed emergency referral, and either need to walk to a transport point or be carried in makeshift stretchers, resulting in much physical and mental distress [58]. Women in the current study utilized motor cycle transport sometimes with multiple passengers on a motor cycle which was rather uncomfortable.…”