title: Ambulance Service Associated With Reduced Probabilities Of Neonatal And Infant Mortality In Two Indian States.
abstract: India had no large-scale, centralized emergency medical system or ambulance service until 2005. Since then, the GVK Emergency Management and Research Institute (GVK EMRI) has emerged as India's largest ambulance service provider, covering more than 630 million people. This study provides the first quantitative evidence of GVK EMRI's early impact on population-level infant and maternal health outcomes in Andhra Pradesh and Gujarat, two Indian states with a combined population of about 145 million people. We found that GVK EMRI coverage is associated with reductions in the probability of neonatal and infant mortality as well as delivery complications (statewide in Andhra Pradesh and in high-mortality districts in Gujarat). However, we found little change in the probability of institutional delivery or skilled birth attendance. Taken together, our findings suggest that population-level health gains were achieved through improvements in the quality (rather than quantity) of maternal and neonatal health services-an interpretation consistent with qualitative reports. More research on this topic is needed.
authors.affiliation: Kimberly S. Babiarz is a research associate at the Center for Primary Care and Outcomes Research at Stanford University, in California.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Babiarz
authors.affiliation: Swaminatha V. Mahadevan is an associate professor of surgery in the Department of Emergency Medicine at Stanford University.
authors.forename: Swaminatha V
authors.initials: SV
authors.lastname: Mahadevan
authors.affiliation: Nomita Divi is a program officer at the Skoll Global Threats Fund, in Palo Alto, California.
authors.forename: Nomita
authors.initials: N
authors.lastname: Divi
authors.affiliation: Grant Miller (ngmiller@stanford.edu) is an associate professor of medicine at Stanford University School of Medicine; director of the Stanford Center for International Development; senior fellow, Freeman Spogli Institute for International Studies, Stanford University; senior fellow, Stanford Institute for Economic Policy Research; and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts.
authors.forename: Grant
authors.initials: G
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000552:Ambulances / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011787:Quality of Health Care / Q000706:statistics & numerical data
keywords: Developing World < International/global health studies; Emergency Management; Health Economics; Maternal And Child Health