The Indian state of Uttar Pradesh (UP), the mostly highly populated in the country and one of the poorest, faces high rates of infant and maternal illness and death. State leaders are committed to addressing this burden, but they aren’t always sure how to proceed—making it hard to take the first step.
For example, one particular danger to women and infants is a persistent lack of reliable emergency transportation. Without this service, women have no way to reach a health facility in time to give birth with skilled care, or, later, to get desperately sick babies to services in time to save their lives.
In 2010, recognizing the urgency of this situation, India’s national government purchased 2,000 ambulances. Their vision was to set up an emergency service to transport poor women and babies to care. Deployed carefully and effectively, this commitment had the potential to save thousands of lives every year. Yet state leaders hesitated, unsure how to implement the new service.
Leaders in UP knew they had a solution at hand—but without a policy or framework to help them apply it effectively and sustainably, progress stalled. For example, how would women access the service? What sort of care would be provided on the way to the facility? And how would the facilities need to be equipped to receive or refer the ambulances? Overall, there was very little existing evidence on best practice for emergency transportation in their context and few models for them to look to. Progress was also held up because the health and infrastructure sectors within the state government were not aligned.
How advocacy unlocked innovation
PATH, a long-time health partner in UP, recognized a policy barrier. We drew on our advocacy expertise, relationships, and experience to strengthen planning and keep the ambulance service project moving forward.
With the government of UP, we convened international and local partners, set up a task team, and gathered data on emergency transport into a series of background papers. At the same time, advocates consulted with and gained buy-in from national and local leaders across sectors.
These papers and insights became the basis for a comprehensive, evidence-based roadmap to guide the new program. In 2013, state officials issued a government order to establish an emergency transport program in UP. In addition, they released a request for proposals, based on the roadmap, which outlined key components of the new program and solicited bids from ambulance companies. In early 2014, the roadmap was formally endorsed by the government of UP.
Finally, the government was ready to launch the emergency transport program.
Today, any pregnant woman or mother with a sick baby in UP can dial a toll-free number and expect an ambulance in 20 to 30 minutes. As a result, thousands of women and babies in the region have better access to the high-quality care they need to start their new lives together.
Project partners: National Rural Health Mission for the state of Uttar Pradesh, State Program Management Unit, National Health System Resource Centre, Population Foundation of India, MANTHAN Project (IntraHealth), and the United Nations Children’s Fund