The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries: a systematic review

Chidiebere Hope Nwolise (Corresponding Author), Julia Hussein, Lovney Kanguru, Jacqueline Bell, Purvi Patel

Research output: Contribution to journalArticle

6 Citations (Scopus)
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Abstract

Objective: Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries.

Methods: Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible.

Results: The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97–15.48) and 3.55 (1.56–8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51–10.38) and 3.37 (1.78–6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality.

Conclusion: There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended.
Original languageEnglish
Pages (from-to)946-955
Number of pages10
JournalHealth Policy and Planning
Volume30
Issue number7
Early online date19 Aug 2014
DOIs
Publication statusPublished - Sep 2015

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Financial Management
Developing Countries
Obstetrics
Emergencies
Maternal Mortality
Health Facilities
Odds Ratio
Obstetric Delivery
Maternal Death
Live Birth
Emergency Medical Services
Databases
Costs and Cost Analysis

Keywords

  • maternal mortality
  • transport
  • community
  • loan funds
  • interventions
  • review
  • emergency obstetric care

Cite this

The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries : a systematic review. / Nwolise, Chidiebere Hope (Corresponding Author); Hussein, Julia; Kanguru, Lovney; Bell, Jacqueline; Patel, Purvi.

In: Health Policy and Planning, Vol. 30, No. 7, 09.2015, p. 946-955.

Research output: Contribution to journalArticle

Nwolise, Chidiebere Hope ; Hussein, Julia ; Kanguru, Lovney ; Bell, Jacqueline ; Patel, Purvi. / The effectiveness of community-based loan funds for transport during obstetric emergencies in developing countries : a systematic review. In: Health Policy and Planning. 2015 ; Vol. 30, No. 7. pp. 946-955.
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N2 - Objective: Scarcity and costs of transport have been implicated as key barriers to accessing care when obstetric emergencies occur in community settings. Community-based loans have been used to increase utilization of health facilities and potentially reduce maternal mortality by providing funding at community level to provide emergency transport. This review aimed to provide evidence of the effect of community-based loan funds on utilization of health facilities and reduction of maternal mortality in developing countries.Methods: Electronic databases of published literature and websites were searched for relevant literature using a pre-defined set of search terms, inclusion and exclusion criteria. Screening of titles, abstracts and full-text articles were done by at least two reviewers independently. Quality assessment was carried out on the selected papers. Data related to deliveries and obstetric complications attended at facilities, maternal deaths and live births were extracted to measure and compare the effects of community-based loan funds using odds ratios (ORs) and reductions in maternal mortality ratio. Forest plots are presented where possible.Results: The results of the review show that groups where community-based loan funds were implemented (alongside other interventions) generally recorded increases in utilization of health facilities for deliveries, with ORs of 3.5 (0.97–15.48) and 3.55 (1.56–8.05); and an increase in utilization of emergency obstetric care with ORs of 2.22 (0.51–10.38) and 3.37 (1.78–6.37). Intervention groups also experienced a positive effect on met need for complications and a reduction in maternal mortality.Conclusion: There is some evidence to suggest that community-based loan funds as part of a multifaceted intervention have positive effects. Conclusions are limited by challenges of study design and bias. Further studies which strengthen the evidence of the effects of loan funds, and mechanism for their functionality, are recommended.

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