RT Journal Article SR Electronic T1 Implementation of a Community Transport Strategy to Reduce Delays in Seeking Obstetric Care in Rural Mozambique JF Global Health: Science and Practice JO GLOB HEALTH SCI PRACT FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs SP S122 OP S136 DO 10.9745/GHSP-D-20-00511 VO 9 IS Supplement 1 A1 Felizarda Amosse A1 Helena Boene A1 Mai-Lei Woo Kinshella A1 Sharla Drebit A1 Sumedha Sharma A1 Prestige Tatenda Makanga A1 Anifa Valá A1 Laura A. Magee A1 Peter von Dadelszen A1 Marianne Vidler A1 Esperança Sevene A1 Khátia Munguambe A1 the Community Level Interventions for Pre-eclampsia (CLIP) Working Group YR 2021 UL http://www.ghspjournal.org/content/9/Supplement_1/S122.abstract AB Key FindingsIt was feasible to implement a community-based transport program in rural areas with no external input of vehicles, fuel, personnel, or maintenance. However, lack of available transporters, barriers to fulfill requirements to opening and managing bank accounts, inequities in affordability of the scheme, and tensions regarding views on how to manage funds were implementation challenges identified that require further support.Positive impacts of program implementation included streamlining the process of identifying transport options and collaborators in the community, pre-negotiating travel prices to increase affordability, raising community attention to the role of transport in reducing delays in health care seeking, and raising awareness on the importance of early recognition of warning signs and prompt care seeking.Key ImplicationsOur community-based transport program uniquely emphasized community ownership and leadership at all stages. Decisions were built by consensus within each community, which allowed for flexibility to local conditions and supported local skill and capacity building for financial management.Transport schemes cannot be implemented in isolation from the wider health system strengthening efforts. This scheme used existing referral pathways rather than creating entirely new processes to help sustainability.Introduction:Delays due to long distances to health facilities, poor road infrastructure, and lack of affordable transport options contribute to the burden of maternal deaths in Mozambique. This study aimed to assess the implementation and uptake of an innovative community-based transport program to improve access to emergency obstetric care in southern Mozambique.Methods:From April 2016 to February 2017, a community transport strategy was implemented as part of the Community Level Interventions for Pre-eclampsia Trial. The study aimed to reduce maternal and perinatal mortality and morbidity by 20% in intervention clusters in Maputo and Gaza Provinces, Mozambique, by involving community health workers in the identification and referral of pregnant and puerperal women at risk. Based on a community-based participatory needs assessment, the transport program was implemented with the trial. Demographics, conditions requiring transportation, means of transport used, route, and outcomes were collected during implementation. Data were entered into a REDCap database.Results:Fifty-seven neighborhoods contributed to the needs assessment; of those, 13 (23%) implemented the transport program. Neighborhoods were selected based on their expression of interest and ability to contribute financially to the program (US$0.33 per family per month). In each selected neighborhood, a community management committee was created, training in small-scale financial management was conducted, and monitoring tools were provided. Twenty people from 9 neighborhoods benefited from the transport program, 70% were pregnant and postpartum women.Conclusion:These results demonstrate that it was feasible to implement a community-based transport program with no external input of vehicles, fuel, personnel, and maintenance. However, high cost and a lack of acceptable transport options in some communities continue to impede access to obstetric health care services and the ability for timely follow-up. When strengthening capacities of community health workers to promptly assist and refer emergency cases, it is crucial to encourage local transport programs and transportation infrastructure among minimally resourced communities to support access and engagement with health systems.