Does the upgrading of the radio communications network in health facilities reduce the delay in the referral of obstetric emergencies in Southern Malawi?

Setting: Mwanza, Phalombe and Zomba districts in the Southern Region of Malawi.
Background: Radios have been installed in many health centers in the Southern Region of Malawi but communication is often indirect. Messages get re-channeled from one health center to another before reaching district hospitals. In an attempt to strengthen the obstetric referral system, the Safe Motherhood Project installed a repeater-based VHF radio communication system in three pilot districts. The overall goal of the new network was to enable the health centers to communicate directly to their district health offices (DHOs) for an ambulance when they have an emergency obstetric complication for referral to the hospital.
Aim: This study aimed to determine whether or not improving the radio communications system reduces the delay in referral of obstetric emergencies from health center to hospital.
Materials and methods: Data collection was conducted between 2001 and 2003 using a range of data collection methods. Radio communications register books were placed at each participating health center to record information on all women with emergency obstetric complications referred to the hospital for further management. An obstetric referral form was completed on each woman referred to the hospital. And using the same referral form, the referral hospital was required to give feedback to the health centers on discharge of the patient. Existing maternity registers or HMIS registers were reviewed to obtain additional information not captured in radio communication registers. Interviews with health center staff were conducted to obtain their communication experiences before and after the new network was installed.
Results: The average number of obstetric admissions per month and the proportion of referrals in the participating health centers significantly increased during the postintervention period. Significantly more emergency obstetric referrals were collected under 1 hour between decision to refer by the midwife at the health center and arrival of transport from the DHO or base station in the postintervention period than pre-intervention period (p<0.02). However, some patients still waited for more than 13 hours for transportation in the post-intervention period. The median time interval between decision to refer and arrival of transport was 3 h. versus 2 h. 3 min. in the pre- and postintervention periods respectively.
Conclusion: This study has demonstrated that the new VHF radio network system has, without doubt, improved the radio communication system in the three pilot districts. However, although the time interval between the decision to refer and arrival of transport significantly improved after the intervention, the majority of transportation still took too long, particularly for someone with postpartum hemorrhage. It is very important to improve the management/control of obstetric ambulances at district level so as to complement efforts of an improved radio communication system in reducing delays in the referral of obstetric emergencies.