Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh

Abstract

BackgroundAlthough safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision.MethodsUsing data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints.ResultsThe seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in public facilities.ConclusionsAlthough EmOC availability and readiness was higher among the surveyed seven most commonly visited private clinics, public facilities appeared to be more affordable for C-section and more geographically accessible. Strategies to retain anesthesiologists and surgeons, such as non-financial incentives, are needed to improve EmOC provision in the public sector. Centralized blood banks are recommended to streamline safe blood acquisition for obstetric surgeries.

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

“…[30][31][32] However, there were differences in the criteria used in assessing the quality of care compared with those used in a previous study, 24 that is, differences in number of signal functions for each category, no distinction of regular versus skilled health professionals, and no use of nonmedical functions.…”

“…The lack of staff, particularly specialized staff, working in public obstetric and newborn care facilities, was also found in previous studies. 21,32 Bangladesh faces the problem of shortage of and unequal distribution of qualified staff in obstetric and newborn care. A previous study found that lack of job openings in government health facilities for nurses was a common barrier to obstetric care programs in rural Bangladesh.…”

“…First, signal functions for assessment of EmNC in this study did not include provision of prophylactic antibiotics to the mother in case of preterm or prolonged premature rupture of membranes, which may limit the ability to compare the findings with other studies. In addition, the number of basic EmONC facilities has fluctuated over the years, 21,32,53,62 possibly due to supply failure or inability to deliver the service (e.g., lack of drugs or absence of a provider, and renovations of maternity wards). Studies that enable a better understanding of this gap will help to guide future preventive interventions.…”

“…The interview questionnaire for EmNC services did not include a 3-month history of service for KMC and providing injectable antibiotics for neonatal sepsis, which was different from the criteria used by other studies. 21,32 Future studies should include assessment of met need and other process indicators for EmONC to allow for a complete understanding of the availability and quality of EmONC services in Bangladesh.…”

Client satisfaction and Competency of Healthcare Providers with the services of BRAC Maternity Centres – A Cross Sectional Study

“…However, recent maternal mortality survey revealed that MMR in Bangladesh has stalled between 2010 and 2016 stagnating at 196 per 100,000 live births (BMMS 2017) .Despite the success stories, the need for professional and trained healthcare providers at rural level is still on the rise. Rural women across Bangladesh has limited access to health services during pregnancy, delivery and postpartum period due to lack of emergency obstetric care (EmOC) facilities in their vicinity, poor financial condition and limited decision-making power (Sikder et al, 2015).…”