title: Using a GIS to model interventions to strengthen the emergency referral system for maternal and newborn health in Ethiopia.
abstract: OBJECTIVE
  To show how GIS can be used by health planners to make informed decisions about interventions to increase access to emergency services.
  
  
  METHODS
  A combination of data sources, including the 2008 national Ethiopian baseline assessment for emergency obstetric and newborn care that covered 797 geo-coded health facilities, LandScan population data, and road network data, were used to model referral networks and catchment areas across 2 regions of Ethiopia. STATA and ArcGIS software extensions were used to model different scenarios for strengthening the referral system, defined by the structural inputs of transportation and communication, and upgrading facilities, to compare the increase in access to referral facilities.
  
  
  RESULTS
  Approximately 70% of the population of Tigray and Amhara regions is served by facilities that are within a 2-hour transfer time to a hospital with obstetric surgery. By adding vehicles and communication capability, this percentage increased to 83%. In a second scenario, upgrading 7 strategically located facilities changed the configuration of the referral networks, and the percentage increased to 80%. By combining the 2 strategies, 90% of the population would be served by midlevel facilities within 2 hours of obstetric surgery. The mean travel time from midlevel facilities to surgical facilities would be reduced from 121 to 64 minutes in the scenario combining the 2 interventions.
  
  
  CONCLUSIONS
  GIS mapping and modeling enable spatial and temporal analyses critical to understanding the population's access to health services and the emergency referral system. The provision of vehicles and communication and the upgrading of health centers to first level referral hospitals are short- and medium-term strategies that can rapidly increase access to lifesaving services.
authors: FHI 360, Research Triangle Park, NC, USA. pbailey@fhi360.org
authors: Patricia E
authors: PE
authors: Bailey
authors: Emily B
authors: EB
authors: Keyes
authors: Caleb
authors: C
authors: Parker
authors: Muna
authors: M
authors: Abdullah
authors: Henok
authors: H
authors: Kebede
authors: Lynn
authors: L
authors: Freedman
mesh_terms: D002662:Child Health Services / Q000458:organization & administration; D003142:Communication; D003657:Decision Making; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D005002:Ethiopia; D005260:Female; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration; D017146:Models, Organizational; D011247:Pregnancy; D012017:Referral and Consultation / Q000458:organization & administration* / Q000592:standards; D012984:Software; D013997:Time Factors; D014187:Transportation of Patients