Fuel For Life

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Saving Mothers Giving Life, unpublished data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: [email protected]