Analytical Review of the Association between Maternal Health Outcomes and Cost of Ambulance Referral Network in Wajir County, Kenya

Abstract

Analytical Review of the Association between Maternal HealthOutcomes and Cost of Ambulance Referral Network in Wajir County, Kenya IntroductionNearly 99% of these deaths occur in developing countries with sub-Saharan Africa accounting for over 50% of global death3. An estimated 73% of these maternal deaths are due to direct obstetric causes while 27.5% are due to indirect cause [4]. Despite the attention experts have given to safe motherhood, the number of women who die in childbirth has changed little in the last 20 years since the 1987 Safe Motherhood Conference in Nairobi, Kenya. In Kenya, maternal mortality remains high at 488 maternal deaths per 100,000 live births [3]. Community ambulance transport to a health facility reduces the 2nd delay [6]. While inter-facility ambulatory transfers to emergency obstetric care facilities reduces the 3rd delay [6]. Most developing countries are restructuring ambulance emergency services but they are limited by budget [5], justifying the need for cost effective analysis of ambulance referral services. A study in a remote setting in Uganda demonstrated that motor vehicle ambulance services within a comprehensive intervention for reproductive health is highly cost-effective [7]. while a study in rural Burundi proved that, within the framework of reproductive health, a motor vehicle ambulance service is cost-ineffective [5]. Kenya has a population of about 44.9 million of which 39.1% are unemployed while 48.3% are females of the reproductive age of 15-49 years with total fertility rate of 3.9 live births per woman [8][9]. The Gross Domestic Product (GDP) per Capita in Kenya is $1,420, equivalent to 9 percent of the world's average [10]. Despite low per capita income in Kenya ($1,420), the government has conventionally provided funding for personnel and operating costs at public hospitals. Kenya's total health expenditure in the fiscal year 2012/13 accounted for 6.8% of gross domestic product (GDP) while government health expenditure as a proportion of total health