Preliminary studies: Focus group discussions revealed poor roads, few vehicles, and high transportation costs as major causes of delay in deciding to seek and in reaching emergency obstetric care.
Interventions: Beginning in September 1992, a four-wheel drive vehicle was posted at Bo Government Hospital (BGH). Motorbikes to summon the vehicle were posted at the eight project-area primary health units (PHUs). Problems with the motorbike system (accidents, breakdowns) led to the installation of a radio system linking the hospital, PHUs and the referral vehicle. These interventions were complemented by community education activities and earlier improvements in the health facilities.
Results: The number of women with major obstetric complications arriving at BGH from the project area increased from 0.9 to 2.6 per month, while case fatality rate dropped from 20% to 10%. In the post-intervention period, approximately half of women with complications from the project area utilizing BGH came by project vehicle. The mean time from the vehicle being called by the PHU to the patient's arrival at BGH was 3.1 h. Case fatality rate did not differ by whether or not women came by project vehicle.
Costs: Cost of the transport and communication intervention was approximately US $75,000, including: vehicle, $27,500; radios, $12,500; motorbikes, $27,000.
Conclusions: Improvements in transport can help greater numbers of women with complications reach hospitals and may improve their chances of survival.