Accessing Maternal and Child Health Services in Sri Lanka and Malaysia
Access to transport enables women to receive timely obstetric care that is essential for their survival. Transport contributes towards reaching the fifth Millennium Development Goal, to reduce maternal mortality by 75 per cent by 2015. Despite differences in income levels and economic growth between Sri Lanka and Malaysia, both countries have been able to make significant reductions in their maternal mortality levels because they managed over time to expand service provision (particularly in rural areas), increase utilization of services, and emphasize quality of service at the health facility to ensure utilization. A key factor behind the progress made in Malaysia and Sri Lanka was the planning of transport measures that linked with and supported the delivery of health services. Transport facilitated and improved access to health facilities to higher levels of health care when health systems were underdeveloped in one location. Measures to stabilize the health condition of women with complications and the availability of blood supplies ensured successful transportation of patients to the next level of care. Early detection by midwives and nurses in rural health centers helped persuade patients to go to the hospital or brought patients to the nearest health center where government transport was available. In both Malaysia and Sri Lanka, free or subsidized emergency transportation was provided in rural areas primarily, whereas ambulatory medical care was gradually and to a greater extent provided by the private sector and financed by user fees. In the absence of, or lack of access to an ambulance or other forms of official transportation (Sri Lanka evidence), field staff were authorized to hire private transportation for emergency referral. In this case, the money was reimbursed by the Ministry of Health – transport evolved from bullock cart or a buggy in remote areas to taxi or private vehicle; telephone access also helped in referral process and efficiency of transport measures (Sri Lanka).