Southern Seven Health Department (S7HD) is the public health authority for Alexander, Hardin, Johnson, Massac, Pope, Pulaski, and Union counties in Illinois. Little or no public transportation serves this area of 2,003 square miles with only six red lights and one McDonald's. Two obstetricians serve the entire area, with limited pediatric services and three hospitals, none of which provide labor and delivery services. An annual household income of $7,000 requires 31% of the area's 73,000 residents to receive public aid. The area has a consistently high unemployment rate, below average housing, a high teen pregnancy rate and a higher than average high school drop out rate. The average infant mortality rate was 15.6 in 1986 and in some areas was as high as 20%. It was determined that one major contributing factor was lack of access to care: over 75% of the population live below the poverty level, without access to services. Ninety-one percent of those served are without an automobile, 60 percent are without telephones.
In the hopes of reducing the infant mortality rate and increasing preventive care and other medical services, the Families with a Future Program of the Southern Seven Health Department provides transportation to non-emergency medical services for pregnant women, infants, and children.
Healthcare providers, case managers, social service agencies, clients, and relatives make referrals to transportation coordinators. Coordinators then schedule and distribute appointments among five transporters. Each transporter has a radio in their car, as well as an agency calling card, so that they may stay in touch with the coordinator in the event of a schedule change. Transporters use their personal vehicles and are reimbursed for travel time and expenses.
Transporters are members of case management teams and are trained in recognizing problems such as substance and child abuse. The transporter also acts as a client advocate, making follow-up appointments, dealing with healthcare systems, and encouraging commitment to attend appointments. Medical providers also use the transporters to contact patients who don't have telephones.
Between 1986 and 1989, the infant mortality rate of the Southern Seven fell from 15.6 to 8.9, achieving the program goal of reducing the rate to nine out of a thousand. Between 1990 and 1992 no disease-related infant deaths were reported. Clients have also begun using the transportation system to a greater degree. Nine hundred and nine patients used it in the fiscal year of 1989; over 1,600 made us of the program's services in fiscal year 1991. The Families with a Future Program of the Southern Seven Health Department has successfully connected a service-desolate area with requisite healthcare.