Mean of completed referrals for FY 2020/2021.

In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data to determine the cost-effectiveness of this intervention in comparison to the standard ambulance system alone. The m-mama program was implemented in six councils of Shinyanga region. The m-mama program data analyzed included costs of referral services using the Emergency Transportation System (EmTS) compared with the standard ambulance system. Analysis was conducted using Microsoft Excel, whose data was fed into a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make a fair comparison between the two systems. During m-mama program implementation a total of 989 referrals were completed. Of them, 30.1% used the standard referral system using ambulance, while 69.9% used the EmTS. The Emergency transport system costed USD 170.4 per a completed referral compared to USD 472 per one complete referral using ambulance system alone. The introduction of m-mama emergency transportation system is more cost effective compared to standard ambulance system alone in the context of Shinyanga region. Scaling up of similar intervention to other regions with similar context and burden of maternal mortality may save cost of otherwise normal emergency ambulance system. Through lessons learned while scaling up, the intervention may be improved and tailored to local challenges and further improve its effectiveness.

为实现可持续发展目标3.1，坦桑尼亚需要投入大量资金，以解决导致绝大多数孕产妇死亡的三大延误问题。为此，坦桑尼亚政府通过“m-mama”项目试点了一项基于社区的应急交通干预措施，用以应对第二大延误问题。本研究通过分析次级数据，评估该干预措施相较于单纯标准救护车系统的成本效益。“m-mama”项目在希尼扬加地区（Shinyanga）的六个地方行政委员会辖区内实施。本次分析的项目数据涵盖了应急交通系统（Emergency Transportation System, EmTS）的转诊服务成本，并与标准救护车系统进行对比。数据分析采用Microsoft Excel软件完成，所得数据被导入TreeAge Pro Healthcare 2022模型开展进一步分析。为确保两套系统间的对比公平合理，所有成本与效益数据均按5%的贴现率进行贴现处理。在“m-mama”项目实施期间，共计完成989例转诊。其中30.1%的转诊采用标准救护车转诊系统，69.9%的转诊使用应急交通系统（EmTS）。每套完整转诊的成本方面，应急交通系统为170.4美元，而单纯使用救护车系统的成本则为472美元。在希尼扬加地区的场景下，引入“m-mama”应急交通系统相较于单纯的标准救护车系统具有更高的成本效益。将此类干预措施推广至具有类似背景和孕产妇死亡负担的其他地区，可节约原本需投入常规应急救护车系统的成本。通过在推广过程中汲取经验教训，该干预措施可得到优化并针对当地实际挑战进行定制化调整，进而进一步提升其实施效益。