Unlocking a lifesaving ambulance service for mothers and babies

June 7, 2019 by PATH

The hands and feet of a mother and daughter—Archana, age 23 and Depika, 9 months old—who live in Uttar Pradesh, India. Photo: PATH/Gabe Bienczycki

The hands of a mother and daughter—Archana, age 23 and Depika, 9 months old—who live in India's most populous state, Uttar Pradesh. Photo: PATH/Gabe Bienczycki

In India, PATH advocates helped a fledgling ambulance service grow into a lifesaving program for mothers and babies.

The opportunity

In Uttar Pradesh—India's most populous state—newborns and their mothers face high rates of illness and death. State leaders were committed to addressing the burden, but they weren’t always sure how to proceed.

In particular, the lack of reliable emergency transportation posed a real danger to mothers and newborns. Without this service, women and adolescent girls had no way to reach a health facility in time to give birth with skilled care. Later, they had no way to get desperately sick babies to the services that could save their lives.

Recognizing the urgency of the situation, India’s national government purchased 2,000 ambulances in 2010. Their vision was to set up an emergency service to transport women and babies to care. Deployed carefully and effectively, this commitment had the potential to save thousands of lives every year. But the project began to stall.

Man driving an ambulance bearing the logo of the National Rural Health Mission Nizamabad, Andhra Pradesh, PATH/Satvir Malhotra

In Uttar Pradesh, a lack of reliable emergency transportation prevented mothers and infants from accessing care. The state government purchased ambulances to start a service. Photo: PATH/Satvir Malhotra

The challenge

Leaders in Uttar Pradesh knew they had a solution at hand, but without a policy or framework to help them apply it, there were too many unknowns.

How would women access the service? What sort of care would be provided on the way to the facility? How would the facilities need to be equipped to receive or refer the ambulances?

At the time, there was little or no evidence for state leaders to go on. No best practices for emergency transportation in their context. Few models to look too for guidance. These uncertainties—along with a misalignment of the state's health and infrastructure sectors—ground progress to a halt.

How advocacy unlocked innovation

PATH, a long-time health partner in the Indian state, recognized a policy barrier. We drew on our advocacy expertise, relationships, and experience to strengthen planning and keep the ambulance service project moving forward.

With the government of Uttar Pradesh, we convened international and in-country partners, set up a task team, and gathered data on emergency transport into a series of background papers. At the same time, advocates consulted with and gained buy-in from national and local leaders.

Today, any pregnant woman or mother with a sick baby can dial a toll-free number and expect an ambulance in 20 to 30 minutes.

These background papers and insights became the basis for a comprehensive, evidence-based roadmap to guide the new program. The plan was first put into action in 2013, and formally endorsed by the state government in 2014.

Finally, after four years of persistence, data-gathering, and partnership, the Uttar Pradesh was ready to launch its emergency transport program.

The outcome

Today, any pregnant woman or mother with a sick baby in Uttar Pradesh can dial a toll-free number and expect an ambulance in 20 to 30 minutes. And that means thousands of women, adolescent girls, and newborn babies have better access to the high-quality care they need.

Read more about this project in our Advocacy Impact Case Study (PDF) about the project. Project partners included the National Rural Health Mission for the state of Uttar Pradesh, State Program Management Unit, National Health System Resource Centre, Population Foundation of India, MANTHAN Project (IntraHealth), and the United Nations Children’s Fund.

Read More