Closing the Gaps: Improving Maternal and Perinatal Outcomes Through Building an Integrated Referral System in Vast Rural Areas

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: In 2008-2012 JSI worked with Russia’s Ministry of Health (MOH) and regional partners to implement the USAID-funded Institutionalizing Best Practices in Maternal and Child Health Project (IBP-MCH). To reduce barriers to safe delivery services, a maternal and newborn (MNH) referral system was piloted in two vast rural areas – Tuymen and Irkutsk regions – with overall 60,000 deliveries/year and distances to maternal facilities up to 1,000 kilometers.

Methodology: An integrated regionalized framework ensuring skilled care at every birth included the following key approaches. Establish clear criteria for designation of maternal units for levels of care integrating emergency response and preterm birth. Develop policy and evidence-based practice guidelines/standards. Establish Emergency Care Counseling Centers. Continually train medical staff at all levels. Organize effective partnerships between the levels of care. Establish transport plans and reliable communication system between facilities and transport teams, and facilitate return transport for mothers with newborns. Work with decision-makers and community to foster the development of regionalization and equitably distributed resources throughout the region, and health staff retaining mechanisms. Audit the effectiveness of the system, maternal and perinatal outcomes and complications.

Results: In project regions maternal deaths per 100,000 live births dropped 70% between 2007 and 2011 (in Irkutsk from 18.1 to 5.4 and in Tuymen from 15.1 to 4.6) while the overall maternal mortality decreased only 33% in Russia. Perinatal mortality rate decreased by 35% in Irkutsk (from 8.6 per 1,000 live births in 2007 to 5.6 in 2011) and by 30% in Tuymen (from 8.1 to 5.7), it was also consistently lower than across the country (20% decrease). The percent of premature births managed at the lowest level declined from 22% to 7.5%.

Conclusion: MOH recognized the project’s successful approaches to effective delivery of the quality MNH services, and endorsed the implementation of the MNH referral system throughout the country.