Reducing maternal newborn mortality through emergency planning and transport in rural Haiti

KOMBIT is a USAID funded child survival project to improve maternal and neonatal health outcomes in the Grand'Anse region of Haiti. It is a partnership between the Haitian Health Foundation, the Sisters of Good Shepherd and the Ministry of Health, implemented by nurses and community health workers (CHW), utilizing innovations in care delivery and community-participation. Haiti has the highest maternal mortality rates in the western hemisphere (600 per 100,000) and a neonatal mortality of 32 per 1000. Emergency obstetrical care (EMOC) is critical for reducing mortality and requires the integration of public health and clinical approaches. In 2006, KOMBIT began related interventions to improve EMOC access: a rapid transport system; village evacuation plans for emergencies; and regional cell phone communication. In the first 6 months of implementation, 10 villages developed and posted evacuation plans, 20 villages and CHWs received cell phones and 43 pregnant women received emergency transport from 16 villages to the government hospital. Maternal and neonatal outcomes for these emergencies were 43 surviving women and 43 neonates. This success and other KOMBIT interventions: community education in danger sign awareness, Home Based Life Saving Skills, and birth planning will increase transport utilization. The hospital has few EMOC technical and human resources, and the addition of 41 obstetric emergencies over-extended its capacity. The health policy implications of this program for resource limited settings are clear—public health interventions can outpace technical capacity and infrastructure of government clinical services. This is especially true in the case of EMOC.