Improving blood availability in a district hospital, Bo, Sierra Leone. The Bo PMM Team

PRELIMINARY STUDIES

A situation analysis of Bo Government Hospital found there was no functioning blood bank. Focus group discussions revealed negative perceptions of community members regarding donation and transfusion of blood.

INTERVENTIONS

In late 1992, the hospital laboratory was refurbished: a refrigerator, freezer, reagents and other equipment and supplies were provided and technicians were trained. Consequently, small quantities of blood could be stored and rapidly transfused. Other improvements to obstetric services in the hospital were undertaken at the same time. Afterwards, community education to encourage blood donation was done.

RESULTS

The number of units of blood drawn increased from 304 to 501 (65%) from 1992 to 1993 (the first intervention year); the number actually transfused increased from 296 to 452 (53%). By the third intervention year (1995), the annual numbers of units drawn and transfused were 469 and 422, respectively. Case fatality rates for major obstetric complications were lower in all post-intervention years (10% in 1993, 7% in 1994, 10% in 1995) as compared to 1992 (13%).

COSTS

Cost of improvements to blood services in the hospital was nearly US $10,000, of which 77% was used to purchase supplies and equipment.

CONCLUSIONS

Even in settings with irregular electrical supply, storage of small quantities of blood is possible. Ready availability of blood may contribute to improved quality of obstetric care and improved survival among patients.

Establishing a cost recovery system for drugs, Bo, Sierra Leone. The Bo PMM Team

PRELIMINARY STUDIES

Focus group discussions and health facility inventories in a rural district hospital indicated a shortage of basic drugs and supplies.

INTERVENTIONS

The project procured obstetric drugs and supplies through a commercial source outside normal government channels. They were managed through the standard district system and made available at prices calculated to cover costs and an 85% mark-up. Obstetric emergency drug packs were created to ensure 24-h availability. Patients from the study area unable to pay at time of treatment were given credit and followed up.

RESULTS

No shortages of obstetric drugs occurred after interventions were introduced. Prices of drugs to obstetric patients ranged from 46% to 68% of the prices charged by the government hospital and private pharmacies. Of 26 obstetric patients from the study area who received drugs in 1993, 12 paid in full and nine paid in part. The total amount billed during 1993 was US $2537, of which $1451 was recovered.

COSTS

Improvements cost approximately $17,500, of which 83% was used for the initial supply of drugs.

CONCLUSIONS

Cost recovery systems for drugs can help maintain consistent drug supplies at health facilities. Careful pricing is critical. For the system to be sustainable, the mark-up must cover defaulters.

Promoting the use of obstetric services through community loan funds, Bo, Sierra Leone. The Bo PMM Team

PRELIMINARY STUDIES

Focus group discussions revealed that a lack of funds often contributed to a delay for women receiving treatment for obstetric complications.

INTERVENTIONS

Improvements were made in health facilities and transport, then, beginning in 1992, meetings were held to mobilize communities to establish emergency loan funds. Per capita levies were set and repayment was enforced by the most paramount chief of the area. Funds were managed by existing village development committees and loans were granted to women who could not pay hospital bills immediately.

RESULTS

Of the six chiefdoms contacted, two successfully established loan funds. Utilization of Bo Government Hospital by women with complications from the two chiefdoms with loan funds increased from five in 1992 to 12 in 1993. Utilization from other chiefdoms remained basically unchanged. Of women from loan fund chiefdoms, half paid their hospital bills in full and one-third paid in part.

COSTS

The cost of community mobilization was about US $472.

CONCLUSIONS

The establishment of loan funds depended on strong community leadership and required substantial mobilization efforts. Where community loan funds are established, utilization of emergency obstetric care may increase.

Facilitating emergency obstetric care through transportation and communication, Bo, Sierra Leone. The Bo PMM Team

PRELIMINARY STUDIES

Focus group discussions revealed poor roads, few vehicles, and high transportation costs as major causes of delay in deciding to seek and in reaching emergency obstetric care.

INTERVENTIONS

Beginning in September 1992, a four-wheel drive vehicle was posted at Bo Government Hospital (BGH). Motorbikes to summon the vehicle were posted at the eight project-area primary health units (PHUs). Problems with the motorbike system (accidents, breakdowns) led to the installation of a radio system linking the hospital, PHUs and the referral vehicle. These interventions were complemented by community education activities and earlier improvements in the health facilities.

RESULTS

The number of women with major obstetric complications arriving at BGH from the project area increased from 0.9 to 2.6 per month, while case fatality rate dropped from 20% to 10%. In the post-intervention period, approximately half of women with complications from the project area utilizing BGH came by project vehicle. The mean time from the vehicle being called by the PHU to the patient's arrival at BGH was 3.1 h. Case fatality rate did not differ by whether or not women came by project vehicle.

COSTS

Cost of the transport and communication intervention was approximately US $75,000, including: vehicle, $27,500; radios, $12,500; motorbikes, $27,000.

CONCLUSIONS

Improvements in transport can help greater numbers of women with complications reach hospitals and may improve their chances of survival.