Promoting the use of obstetric services through community loan funds, Bo, Sierra Leone. The Bo PMM Team.

PRELIMINARY STUDIES: Focus group discussions revealed that a lack of funds often contributed to a delay for women receiving treatment for obstetric complications. INTERVENTIONS: Improvements were made in health facilities and transport, then, beginning in 1992, meetings were held to mobilize communities to establish emergency loan funds. Per capita levies were set and repayment was enforced by the most paramount chief of the area. Funds were managed by existing village development committees and loans were granted to women who could not pay hospital bills immediately. RESULTS: Of the six chiefdoms contacted, two successfully established loan funds. Utilization of Bo Government Hospital by women with complications from the two chiefdoms with loan funds increased from five in 1992 to 12 in 1993. Utilization from other chiefdoms remained basically unchanged. Of women from loan fund chiefdoms, half paid their hospital bills in full and one-third paid in part. COSTS: The cost of community mobilization was about US $472. CONCLUSIONS: The establishment of loan funds depended on strong community leadership and required substantial mobilization efforts. Where community loan funds are established, utilization of emergency obstetric care may increase.