Fuel For Life


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Mobile phones and mobile money to expand access to emergency obstetric care

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Fuel For Life

  1. 1. Fuel For Life A Model to Increase Access to Timely Emergency Obstetric Care in Uganda
  2. 2. The Problem Every day, 800 women die from preventable pregnancy complications
  3. 3. Why are Mothers Dying? Three Critical Delays lead to 75% of Deaths from preventable complications  Delay in seeking care  Delay in transportation – reaching an adequate health facility  Delay in receiving appropriate care
  4. 4. A Daily Occurrence Imagine 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?
  5. 5. Why are Mothers Dying? Three Critical Delays lead to 75% of Deaths… preventable deaths 1. Delay in seeking care 2. Delay in transportation – reaching an adequate health facility 3. Delay in receiving appropriate care
  6. 6. Barriers to Care 1st Delay •Perceived value 2nd Delay •Communication •Cost 3rd Delay •Supplies, Staffing, & Training •Advanced Notification WHO: Reducing Maternal Deaths, 2001
  7. 7. Paper Transport Vouchers Increased Skilled Attended Deliveries Ekirapa-Kiracho et al. BMC Intl Health Human Rights 2011
  8. 8. Referrals Vouchers Implementation of SMGL voucher program Saving Mothers Giving Life, unpublished data
  9. 9. Paper Vouchers are Unsustainable • Inefficient • Cumbersome overhead • Subject to Fraud & Abuse THEREFORE NOT SCALABLE
  10. 10. Paper 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)
  11. 11. Mobile Network e-Fuel Vouchers Faster, Efficient & Scalable
  12. 12. Fuel 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
  13. 13. Grass Roots Emergency Maternal Response 1a 1 Hospital Ambulance Community Drivers Dispatch 1b 1. Midwife activates emergency alert 2 2. Driver selected; Midwife notified; clinical information captured & transmitted to Hospital 3. Patient promptly transported to hospital 4. Hospital Referral confirmed, Driver compensated 4 3 Picks up Patient
  14. 14. Not Only Emergencies • Community Vouchers Can Increase Demand • Antenatal Care • Skilled Attended Deliveries
  15. 15. Facilitating Community to Hospital Dispatch Patient is registered at Antenatal Care
  16. 16. Facilitating Community to Hospital 4. Dispatch 6. 5. 2. 3. 1. 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
  17. 17. Rapid, Efficient Transport Delay #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
  18. 18. Mobile Maternal Health Log • Facilitate M&E of Utilization and Outcome reporting Paper  Electronic data base • Facilitates Real Time Reporting • Expedited Measurement/Evaluation • Optimized Resource Management
  19. 19. Future Integration: Partograph • Charts progress in labor • Records fetal and maternal condition during labor • Detects abnormal events and patterns
  20. 20. 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
  21. 21. mParto Winner of the 2012 Microsoft Imagine Cup • 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
  22. 22. FUEL For LIFE A Community Led, Emergency Obstetric Referral System
  23. 23. Join Us Today Contact: Peter Klatsky M.D., M.P.H. Department of Obstetrics & Gynecology Albert Einstein College of Medicine, Montefiore Medical Center Email: pklatsky@montefiore.org