Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

Abstract

BackgroundSignal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh.MethodsAn assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district.ResultsCaesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities.ConclusionsIn the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh.

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving Universal Health Coverage in Tanzania

“…Therefore, there is a need to invest more on training and more investment on the safe blood transfusion services. The findings from this study is similar to that of Roy et al (2017) which was conducted in Bangladesh which showed that of all signal functions coverage for both Caesarean section and blood transfusion services had less than 1% [39].…”

Development and upgrading of public primary healthcare facilities with essential surgical services infrastructure: a strategy towards achieving universal health coverage in Tanzania

“…Therefore, there is a need to invest more on training and more investment on the safe blood transfusion services. The findings from this study is similar to that of Roy et al [38] which was conducted in Bangladesh which showed that of all signal functions coverage for both Caesarean section and blood transfusion services had less than 1%.…”

“…manual vacuum extraction, dilatation, and curettage), (vi) performing assisted vaginal delivery (AVD), i.e. vacuum extraction or forceps delivery, (vii) performing basic neonatal resuscitation), (viii) performing CS delivery, and (ix) Safe Blood Transfusion services to be available for 24 h a day, 7 days a week [36][37][38].…”

Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

“…However, the role of village doctors as the predominant providers for the poor in this context cannot be ignored and our findings suggest they are already integrated in infection management practices for young infants in the community. Previous research has promoted public-private partnerships (PPP) to improve nationwide coverage of emergency obstetric and newborn care in Bangladesh [55]. Future studies are needed to examine the potential for engaging informal and formal private providers, including the potential for fostering public-private partnerships (PPP) in this context [18,53,54].…”

“…Future studies are needed to examine the potential for engaging informal and formal private providers, including the potential for fostering public-private partnerships (PPP) in this context [18,53,54]. Previous research has promoted PPP to improve nationwide coverage of emergency obstetric and newborn care in Bangladesh [55]. Additionally, public sector providers' opinions around engaging with private providers as allies should be explored as this has previously been identified as a barrier to implementation of PPP [56].…”