Intermediate policy recommendation for reducing maternal mortality on the Eastern Tibetan Plateau

The current policy recommendation for reducing maternal mortality is to increase access to emergency obstetrical care (EmOC). This policy is difficult to implement in isolated, impoverished communities of the developing world. Currently almost 100% of the births on the Eastern Tibetan Plateau take place at home due to distance to the referral hospitals, and inability to pay hospital fees. Until access to EmOC is achieved, the collaborative Tibetan/US team is evaluating methods for making home births safer through the training of family members in a modified version of Home Based Life Saving Skills (HBLSS) and the creation of a distribution system for birthing kits (BKs). Working with a midwife from the referral hospital, the project was able to train 3 local public health educators and 3 village community health workers in HBLSS to prevent problems during pregnancy and delivery, and to make timely referrals to EmOC when needed. They distributed BKs to households with expectant mothers and trained family members in the use of the BKs. Recipients of the BKs reported confidence in using all the kit items, and praised the convenience and cleanliness of the kits. An unintended - yet beneficial - consequence of the BKs was cost savings for women when they presented at the referral hospital. The BKs saved women Y200 (USD25) in hospital fees, thus becoming a facilitator in accessing hospital care. This project suggests that intermediate health policy should focus on increasing capacity at the household level in addition to EmOC.