Boat referral system connects remote communities to maternity units

In Zumarraga town in Samar, an Inter-island Health Referral System - Strengthening through one facility, one health service boat project was adopted to address access barriers to women in need of facility-based deliveries. Dr. Katerina Nono-Abiertas, founder of the One Health Service boat, explains that the set-up enables patients to access health centers by having boats ferry them to maternity units.

Initially, they started with one boat that had to cater 25 barangays in Zumarraga. At present, four low-cost, fuel-efficient, and cost effective service boats were added to the fleet after donations came in from other doctors.  

According to the Asian Development Bank, there are 114 maternal deaths per 100,000 live births in the Philippines in 2017.  Through facility and service improvements and promotion of facility-based deliveries, an increase in facility-based births results in fewer women dying at home and better postpartum care. But for geographically isolated and disadvantaged areas (GIDA), reaching the said facilities prove to be a significant hurdle.

Dr. Nono-Abiertas shared that by training health personnel, engaging the mayor and barangay health workers, developing an ordinance, and creating a hotline to contact the center, they were able to develop a system that not only provided access to GIDAs, but they also managed to change the delivery of health services and enhanced the health workers’ motivation.

The innovation is in the financial model which was developed to create sustainability by upgrading and expanding maternal health facilities to become accredited by PhilHealth, which in turn, will enable the facility to receive reimbursements to fund the operation and maintenance of the sea ambulances. Through this set-up, facility-based deliveries rose from 20% to 90%, created employment for men as boat operators, and improved the health workers’ morale and motivation.

Dr. Nono-Abiertas emphasized in her presentation the need to care for health workers, saying “If we really want people-centered health systems, people should not come first, health workers should come first,” and that by ensuring the people working on the ground are cared for, effective patient care will follow.

Lastly, she added the importance of first-hand field experience and empathizing with the community, inviting other researchers and stakeholders to visit the field and find time to work with the communities.

The One Health Boat project is one of the top five models of social innovations in the country recognized by the World Health Organization (WHO) and the Social Innovation in Health Initiative (SIHI). Dr. Nono-Abiertas was invited to be part of the panel discussion on Research on Social Innovations in Health during PCHRD’s 36th anniversary celebration on March 16 at the Philippine International Convention Center.