Earlier this morning while going on rounds with the doctors at the hospital, I realized how easily we take ambulance services for granted in the US. I was standing in the inpatient department excited to hear that the mother and child, who was delivered by Bayalpata’s second Cesearean section, were doing well, when I was asked to go to the front of the hospital to take some pictures. A mother had just arrived and was finishing the delivery process, which had started in the jeep transporting her to the hospital. The nurses were quick to help her out, severing the baby’s cord in order to quickly bring her to the warming table in the IPD. Then they helped the mother out of the jeep so that she could finish the process of labor in a more sterile environment. In a matter of minutes the baby was wrapped up with her clothes on, the mother was walking around, and the nurses were busy preparing for yet another birth.
After the craziness of the moment settled down, I began to wonder why the mother had come to the hospital, knowing that it was likely she would deliver in the jeep, clearly not an ideal situation. Without even having to ask, one of the nurses provided me with the answer, “You know many women come here even they know its too late. That way they can still receive the delivery incentive. In 2005 Nepal created the Safe Delivery Incentive Program (SDIP), which provides mothers an incentive to deliver at a health facility. Here in Achham, the incentive in 1,000 rupees. This program was a response to the high costs associated with accessing care, particularly in rural areas as well as overall low rates of skilled-birth attendants present at deliveries. Over the last three years deliveries have increased 350% from an average of only 6 delivers per month to an average of 26 deliveries per month since the opening the hospital. We are now seeing about one delivery per day as more and more women choose to access these services at the hospital, but as this case demonstrates even such a well intentioned program can have unintended consequences.