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Massive ambulance service reduces neonatal and infant mortality in India

A mom and her newborn baby at the Maternal & Child Health Training Institute for medically needy in Dhaka, Bangladesh.

High infant and neonatal mortality rates are one of the most challenging health dilemmas plaguing India today.

UN Photo/Kibae Park
Nov 20 2016

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Research Spotlights

By Beth Duff-Brown

In 2007, scholars at Stanford Medicine joined forces with the Indian nonprofit GVK Emergency Management Research Institute (EMRI) for an enormous undertaking: build an ambulance system across the world’s second most populous nation.

A decade ago, EMRI had only 14 ambulances in India.

Today, EMRI oversees a fleet of nearly 10,000 ambulances, manned by some 20,000 medical professionals who ply the roads in cities and rural villages to provide access to emergency care to 750 million people — three-quarters of India’s population. Stanford instructors developed an educational curriculum and trained the initial group of 180 skilled paramedics and instructors.

A new study by SCID Director Grant Miller and fellow Stanford researchers shows the positive impact this organization’s services are having on reducing infant and neonatal mortality rates, one of the most challenging health dilemmas plaguing India today. The research was published in the October edition of Health Affairs. It is the first analytical research on the impact of the ambulance service.

Infant deaths in India are falling, but remain the highest in the world

In 2005, one quarter of infant deaths worldwide occurred in India. In 2014, the number of infant deaths in India dropped below one million for the first time. Explore the map below. Hover over countries to view infant deaths and infant mortality rates (number of infant deaths per 1,000 live births). Toggle between years to explore changes over time.

Map credit: Emily Miller

“It's wonderful to find a model that has found some success in connecting mothers and their infants with high-quality and timely emergency care when it is most needed,” said Kimberly Singer Babiarz, a research scholar at Stanford Health Policy and lead author of the paper.

The public-private nonprofit provides its services free of charge and most of its beneficiaries are the poorest of the poor.

About one-third of the toll-free calls to the emergency services number are from women in labor. Deliveries have traditionally been done at home, particularly in rural villages, where women often die of complications. The Stanford team designed a special obstetrics curriculum and helped create the country’s first protocols for obstetric care.

Grant Miller, SCID director and senior author of the study, has worked on many health policy projects in India over the years. The results aren’t always hopeful.

“I’ve conducted a number of evaluations of large-scale health programs in India, and there are disappointingly few programs and policies that we’ve found to be effective,” said Miller, who is also an associate professor of medicine and a senior fellow at the Stanford Institute for Economic Policy Research. “So it’s exciting to find one that may have worked quite well.”

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