Readiness of rural health facilities to provide immediate postpartum care in Uganda

Abstract

Background Nearly 60% of maternal and 45% of newborn deaths occur within 24 h after delivery. Immediate postpartum monitoring could avert death from preventable causes including postpartum hemorrhage, and eclampsia among mothers, and birth asphyxia, hypothermia, and sepsis for babies. We aimed at assessing facility readiness for the provision of postpartum care within the immediate postpartum period. Methods A cross-sectional study involving 40 health facilities within the greater Mpigi region, Uganda, was done. An adapted health facility assessment tool was employed in data collection. Data were double-entered into Epi Data version 4.2 and analyzed using STATA version 13 and presented using descriptive statistics. Results Facility readiness for the provision of postpartum care was low (median score 24% (IQR: 18.7, 26.7). Availability, and use of up-to-date, policies, guidelines and written clinical protocols for identifying, monitoring, and managing postpartum care were inconsistent across all levels of care. Lack of or non-functional equipment poses challenges for screening, diagnosing, and treating postnatal emergencies. Frequent stock-outs of essential drugs and supplies, particularly, hydralazine, antibiotics, oxygen, and blood products for transfusions were more common at health centers compared to hospitals. Inadequate human resources and sub-optimal supplies inhibit the proper functioning of health facilities and impact the quality of postpartum care. Overall, private not-for-profit health facilities had higher facility readiness scores. Conclusions Our findings suggest sub-optimal rural health facility readiness to assess, monitor, and manage postpartum emergencies to reduce the risk of preventable maternal/newborn morbidity and mortality. Strengthening health system inputs and supply side factors could improve facility capacity to provide quality postpartum care.

Midwives’ perceptions towards the ministry of health guidelines for the provision of immediate postpartum care in rural health facilities in Uganda

“…Consequently, there were variations in the care provided, which has implications for quality of care experienced by the postpartum women. Besides, even where guidelines were available, protocols and job aides to simplify the guidelines were either not available or not routinely used [ 20 ]. Given that the WHO guideline development group recognized that many of their recommendations were based on routine practice in developed countries and low level evidence, contextual studies need to be done to establish the best practices for immediate postpartum care provision [ 1 , 2 ].…”

“…The variations in the postnatal care provided is in agreement with a review to assess the use of postnatal health-care services in low and middle-income countries, where use of postnatal care services was found to be highly inequitable and varied markedly with socioeconomic status, between facilities in the same country and region, and between urban and rural residents [ 45 ]. This may be related to absence of management protocols, failure to use available guidelines, and variation in facility readiness (absence of necessary medications, equipment, infrastructure, staff numbers, staff skills and poor staff motivation) [ 7 , 20 ].…”

“…Our recent study on the facility readiness to provide immediate postpartum care showed that the dissemination of the MOH guidelines and their adoption into facility policies was low. We also found that many facilities lacked hospital policies and protocols for the provision of immediate postpartum care [ 20 ]. Over half of the rural facilities assessed had no scores for the routine monitoring of mothers and their newborns according to the MOH guidelines.…”