EMAS Program Brief - Origins of Referrals - FINAL

The program is a five-year initiative implemented across six provinces with the largest burden of maternal and newborn mortality. EMAS works directly with 150 hospitals, 300 community health centers (puskesmas), and with governmental and other stakeholders in 30 districts. The program focuses on improving the quality of care within health facilities and strengthening the referral system to ensure efficient and effective referrals from the health center to the hospital. EMAS has been implementing quality improvement interventions within target hospitals and puskesmas for approximately three years in Phase 1 facilities and for approximately one and a half years in Phase 2 facilities. Significant strides have been made in achieving high coverage of priority, life-saving maternal interventions in hospitals, including provision of magnesium sulfate (MgSO4) to treat pre-eclampsia/eclampsia (PE/E) and the use of a uterotonic in the third stage of labor to manage post-partum hemorrhage. An analysis was conducted to better understand where referral cases in EMAS target hospitals originated and whether stabilization practices vary based on referral origin. The analysis focused on the two before-referral indicators collected in EMAS-supported hospitals: the percentage of women with severe PE/E who are referred to EMAS-supported hospitals and who receive at least one dose of MgSO4 before referral, and the percentage of newborns with suspected severe infection who are referred to EMAS-supported hospitals and who receive at least one dose of antibiotics before referral. The analysis found that the vast majority of referral cases for women with severe PE/E and newborns with suspected severe infection originated from within the same district as the hospital. Women with severe PE/E were provided with at least one dose of MgSO4 prior to referral at significantly higher rates if they were referred from a facility that was supported by EMAS. Nearly three-quarters of women with severe PE/E had received at least one dose of MgSO4 prior to referral when coming from a full-support puskesmas or hospital supported by EMAS. In contrast, newborns with suspected severe infection were more likely to originate from private midwives and hospitals, rather than puskesmas. However, cases referred from EMAS-supported facilities were most likely to be stabilized with MgSO4 before referral. The findings suggest that EMAS-supported facilities are more effective in stabilizing women and newborns before referral to a higher level of care.