# Enhancing emergency obstetric care navigation through a ‘Welcome Person’ model: insights from a health system strengthening initiative in Bangladesh

## TL;DR

A 'Welcome Person' model was tested in Bangladesh to improve emergency maternal care by guiding pregnant women through health facilities, reducing delays and improving treatment times.

## Contribution

The study introduces and evaluates the 'Welcome Person' model as a novel approach to address the third delay in maternal care in Bangladesh.

## Key findings

- The median time from entry to treatment was 15 minutes, with no significant difference between complicated and uncomplicated cases.
- Upazila Health Complexes outperformed District Hospitals in completing procedures within median times.
- The 'Welcome Person' model showed potential to improve patient experiences and outcomes in emergency obstetric care.

## Abstract

Maternal mortality remains critical in Bangladesh, driven by delays in accessing timely care at health care facilities. Globally, a woman dies every two minutes from pregnancy or childbirth, often due to systemic inefficiencies in health care. In Bangladesh, high maternal mortality rates are worsened by overcrowded facilities, limited resources, and complex procedures. The 'three delays' model identifies barriers to care, with the third delay – receiving timely treatment – being a major contributor to maternal deaths. This study aims to generate evidence on how the ‘Welcome Person’ can improve maternity care at the facility level in Bangladesh.

We conducted a cross-sectional study from April to December 2022 among pregnant women at three selected health care facilities in Gaibandha District, Bangladesh. We deployed 20 ‘Welcome Persons’ to navigate and assist pregnant women, enhancing maternal health care. The Welcome Persons provided round-the-clock support, guiding mothers from the moment they entered the hospital through their admission, treatment, and any necessary referrals. The Welcome Persons maintained detailed time-stamped records, tracking patient movements and service timelines.

In this study of 5260 mothers, 47% presented with complications, with 52% arriving after office hours. The median time from entry to treatment was 15 minutes, with those without complications taking 14 minutes and those with complications 15 minutes. Entry-to-admission took a median of nine minutes, varying by age, with younger patients completing faster. Admission-to-treatment had a median time of six minutes, with severely complicated patients experiencing shorter times. Only 1% completed within five minutes, while 63% finished within 15 minutes. Upazila Health Complexes (UHCs) showed better performance in completing procedures within median times compared to the District Hospital (DH). Future study plans should include measuring maternal and neonatal outcomes as well.

This study demonstrates that timely maternal care is achievable by deploying a support person. Using the ‘Welcome Person’ model to address admission bottlenecks, health care facilities can enhance patient experiences and outcomes. Despite a few limitations, evidence generated from this study can be utilised for scaling up decisions and can contribute to the health policy.