Access to emergency medical services (EMS): A critical factor in reducing maternal deaths
Most maternal deaths are preventable with timely access to quality care. Emergency medical services (EMS), which includes a robust network of emergency communication systems, referral and transportation mechanisms, and well-trained emergency health responders, play a crucial role in saving the lives of pregnant women experiencing a health crisis. The positive impact of robust EMS to support mothers extends to newborns and their families. Despite its importance, reliable obstetric emergency transportation and referral services are where most maternal deaths occur.
Robust EMS systems are especially important for women and families living in rural and remote areas, who are often from indigenous or other marginalized communities and already face disproportionately high negative health outcomes due to limited access to maternal health services. As a result, it is essential for governments to invest in strengthening EMS to save more women’s lives.
Integrating EMS into an effective maternal health response
In LMICs, EMS are an increasingly important essential health service of interest to local maternal health innovators who are looking to apply their technical expertise to prevent maternal deaths. Strengthening Systems for Safer Childbirth is an MSD for Mothers-funded initiative to improve access to high-quality, respectful maternal health care in India, Kenya, Nigeria, and Sierra Leone. Six locally-led, multi-sector coalitions – composed of leading health care businesses, NGOs, technology companies, advocacy groups, and national and local level government stakeholders – are strengthening health systems through a range of sustainable solutions to increase capacity for quality service delivery and improve maternal health outcomes.
As these coalitions work to address critical unmet maternal health needs within their communities, EMS have emerged as a priority, especially for pregnant women. In rural Kenya, where emergency services remain disjointed and unavailable, it can take a pregnant woman nearly a day to travel to a health facility by foot. Sierra Leone, a country with one of the worst maternal health outcomes worldwide, can attribute 98% of its maternal deaths to delays in accessing health care services.
Through public-private partnerships, the coalitions in Kenya and Sierra Leone are addressing these challenges and focusing their efforts on building more resilient EMS. In Sierra Leone, Wellbody, a multi-sector coalition composed of Partners in Health Sierra Leone, LifeBank, Janitri, the Sickle Cell Carers Awareness Network, and the National Emergency Medical Services, is addressing gaps in the supply and demand for EMS in Koidu county through building clinical capacity to make emergency referrals and improving the county’s referral system. In Kenya, MamaLink, led by Rescue.co, the leading emergency rescue provider in East Africa, is providing lifesaving services to pregnant women in Nairobi and Siaya counties by deploying an emergency response hotline that uses a cloud-based platform to efficiently dispatch private and public ambulances,
The value of efficient EMS
To achieve the Sustainable Development Goals (SDGs) and the WHO, UNICEF, and UNFPA’s Every Women Every Newborn Everywhere (EWENE) global target of having at least half of the population able to access emergency obstetric services, LMICs urgently need more integrated EMS. The coalitions in Kenya and Sierra Leone are at the forefront of leveraging the private sector to integrate EMS as a core part of addressing local maternal health care challenges.
| Why is EMS important? | MamaLink (Kenya) | Wellbody (Sierra Leone) |
|---|---|---|
| EMS are vital to ending preventable maternal deaths. Postpartum hemorrhage (PPH) and hypertensive disorders (pre-eclampsia and eclampsia) are the leading causes of maternal mortality in LMICs and require immediate identification and management to save a woman’s life. | MamaLink established a 24/7, toll-free emergency hotline service that dispatches public and private ambulances to women in need. Using a cloud-based digital platform, known as Flare technology – owned by East Africa’s leading emergency rescue provider, Rescue.co – MamaLink rapidly identifies and deploys an available ambulance upon receiving an emergency call. Once dispatched, Flare’s state-of-the-art technology places the location of the ambulance on a digital map and routes it to the emergency. MamaLink socializes the emergency hotline with the community via engagement strategies. MamaLink created partnerships with vetted local emergency providers to build a network that supports women in even the most remote communities with access to emergency transport services as well as essential medical care from trained health care providers while in route to a health care facility. Since launching in 2020, MamaLink has reduced average response times from more than two and a half hours (162 minutes) to just 15 minutes in Nairobi County and provided emergency response services to over 12,000 pregnant women. | Wellbody partnered with the National Emergency Medical Services (NEMS) in Sierra Leone to establish an emergency referral and transport system to transport women from a community facility to the Koidu government hospital for specialized emergency care. NEMS plays a vital role in Sierra Leone’s health care system by providing emergency medical care and transportation to individuals in need across the country. |
| Ambulance-based referral systems are a sustainable and cost-effective investment. Relatively small investments in EMS can have a substantial impact on maternal health outcomes, while simultaneously reducing health system inefficiencies and limiting catastrophic health spending to protect local health economies. | MamaLink conducts a triage assessment at the scene of an emergency to identify the most appropriate facility that has the capacity to provide immediate medical care to a woman experiencing a life-threatening obstetric emergency. Specifically, MamaLink determines which women can be treated at lower-level facilities, thus saving finite health care resources and lowering the burden on hospitals. Over the past year, 94% of all pregnant women transported were transferred to the appropriate facility as the first stop – decreasing inefficiencies, improving health outcomes, and reducing the burden on Nairobi’s facilities. | Wellbody helps women receive coordinated, high-quality care immediately upon reaching the hospital, Wellbody is training health care providers at the Koidu hospital to effectively triage and deliver emergency obstetric services, while also supplying the hospital with essential tools to enable delivery of services. Wellbody focuses on improving quality at every step of the emergency response journey by strengthening health system capacity and reducing inefficiencies and fragmentation – leading to better outcomes for mothers and their newborns. Between January 2023 and October 2024, the Wellbody coalition coordinated more than 750 referrals and emergency response services – enabling access to lifesaving obstetric care that resulted in zero maternal deaths. |
| EMS are an untapped source of data on health and social needs. Emergency medical response services capture real-time data on population health trends at the community level, including data on the social drivers of health – valuable information that can guide allocation of health resources. | MamaLink collects data on all their touchpoints with women – through community health volunteers, call centers, antenatal clinic visits, and emergency dispatches and referrals. The coalition uses this community-level data to better understand and address health care needs and trends across the population. MamaLink analyzes what prompted an emergency referral – offering valuable insights into local health needs and health facilities’ capacity challenges. For example, using data collected from their referral services, MamaLink noticed a large proportion (nearly 60%) of neonatal referrals from moderate to higher-level facilities being sent to Kenyatta National Hospital, strongly demonstrating the critical need for more specialized neonatal care. MamaLink provided compelling evidence to the Nairobi County Health Management Team on the urgent need for specialized neonatal care across all facilities. This advocacy led to the establishment of a neonatal intensive care unit at Mbagathi Hospital. Equipped with nearly 50 incubators, the additional neonatal unit has significantly boosted the county’s capacity to manage neonatal care. | Wellbody collects provider and emergency system performance data on each referral received at the Koidu hospital. Wellbody leverages the data to continuously identify opportunities to further improve the quality of maternal health care and strengthen the delivery of women-centered care practices. Wellbody implemented a process to review cases of preventable maternal morbidity or maternal mortality, supporting the coalition and the hospital to evaluate and better understand the causes and identify system-level solutions. By regularly reviewing and analyzing emergency response and performance data, Wellbody has significantly improved their ability to provide timely, quality care to women in need and reduce preventable maternal deaths. Furthermore, Wellbody actively shares its findings and recommendations with Ministries of Health (MOH) to ensure that this work translates into meaningful, system-level changes that improve health care outcomes for all. |
Considerations for national health leaders
By investing in EMS and providing women with access to timely, high-quality emergency maternal care, we can significantly reduce maternal mortality and improve the overall health and well-being of communities. We urge national and local policy makers responsible for quality maternal health outcomes to recognize the value that EMS can bring to health care systems and consider the following recommendations:
- Integrate EMS into maternal and neonatal health plans: implement policies at the national and local level that increase access to and availability of quality EMS around pregnancy and childbirth – such as monitoring the quality of EMS systems.
- Create budgetary headroom for EMS: allocate specific funding in health budgets to strengthen EMS – including centralized communication networks, emergency referral systems, and specialized obstetric training for emergency health care providers.
- Drive efficiency by collaborating with the private sector: support and create public-private partnerships to augment the capacity and resources of the public health sector by leveraging private ambulance services and/or technology to increase access to quality EMS.
- Optimize the value of EMS: invest in (1) building the capacity of health care providers and equipping facilities to manage pregnancy-related emergencies as soon as a woman arrives and (2) improving transportation infrastructure – including roads and navigation systems – to decrease transit time to health facilities.
- Build population awareness of, and trust in, local EMS: promote education and awareness of emergency response services and empower communities to make informed decisions about seeking emergency care, enhancing the effectiveness of EMS and improving patient outcomes.
- Leverage data to continually optimize and improve emergency medical systems: invest in robust and comprehensive data systems to continuously reveal opportunities to improve both health outcomes and service delivery.
The coalitions within the Strengthening Systems for Safer Childbirth initiative have demonstrated the vital role EMS play in addressing the challenges many pregnant and postpartum women and families confront in low-resource settings. As country governments strive to strengthen health care systems and achieve the health-related Sustainable Development Goals, including reducing maternal mortality, they must prioritize building resilient and high-quality EMS.
About the authors:
- Iyadunni Olubode is the Director of Nigeria Programs for MSD for Mothers
- Temitayo Erogbogbo is the Lead, Multilateral Organizations Engagement at MSD and Global Advocacy Director for MSD for Mothers
- Caitlin Dolkart is the Managing Director of Rescue.co
- Isata Dumbuya is the Director of Reproductive, Maternal, Neonatal and Child Health at Partners in Health