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

BMC Public Health

Parul Christian¹  Keith P West¹  Sucheta Mehra¹  Rolf DW Klemm¹  Abu AM Hanif²  Hasmot Ali²  Alain B Labrique¹  Shegufta S Sikder¹ 

[1] Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh

关键词: Human resources for health;    Global health;    Quality of care;    Emergency obstetric care;    Rural Bangladesh;    Maternal health;   

Others  :  1122831
DOI  :  10.1186/s12889-015-1405-2

 received in 2013-11-04, accepted in 2015-01-12,  发布年份 2015

【 摘 要 】

Background

Although 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.

Methods

Using 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.

Results

The 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.

Conclusions

Although 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.

【 授权许可】

   
2015 Sikder et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]National Institute of Population Research and Training (NIPORT): Mitra and Associates, MEASURE Evaluation, icddr,b. Bangladesh maternal mortality and health care survey 2010: summary of key findings and implications. NIPORT, Dhaka, Bangladesh; 2012.
• [2]Program Preparation Cell, Ministry of Health and Family Welfare (MOHFW): Framework of 2011–2016 health, population, and nutrition sector development program. MOHFW, Dhaka, Bangladesh; 2012.
• [3]Koblinsky M, Chowdhury ME, Moran AC, Ronsmans C: Maternal morbidity and disability and their consequences: neglected agenda in maternal health. J Health Popul Nutr 2012, 30:124-30.
• [4]Lee AC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, et al.: Linking families and facilities for care at birth: what works to avert intrapartum-related deaths? Int J Gynaecol Obstet 2009, 107(Suppl 1):S65-8.
• [5]World Health Organization: Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. WHO, Geneva; 2010.
• [6]Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder AA, et al.: Overcoming health-systems constraints to achieve the millennium development goals. Lancet 2004, 364:900-6.
• [7]Paxton A, Bailey P, Lobis S: The United Nations process indicators for emergency obstetric care: reflections based on a decade of experience. Int J Gynaecol Obstet 2006, 95:192-208.
• [8]Management Information Systems: Directorate General of Health Services. Health Bulletin 2012. Ministry of Health and Family Welfare, Dhaka, Bangladesh; 2013.
• [9]Anwar I, Kalim N, Koblinsky M: Quality of obstetric care in public-sector facilities and constraints to implementing emergency obstetric care services: evidence from high- and low-performing districts of Bangladesh. J Health Popul Nutr 2009, 27:139-55.
• [10]Mridha MK, Anwar I, Koblinsky M: Public-sector maternal health programmes and services for rural Bangladesh. J Health Popul Nutr 2009, 27:124-38.
• [11]Minca M: Midwifery in Bangladesh: in-depth country analysis. World Health Organization, Geneva; 2011.
• [12]National Institute of Population Research and Training (NIPORT), Mitra and Associates, Macro International: Bangladesh demographic and health survey 2011. Macro International, Dhaka, Bangladesh and Calverton, Maryland, USA; 2012.
• [13]Labrique AB, Christian P, Klemm RD, Rashid M, Shamim AA, Massie A, et al.: A cluster-randomized, placebo-controlled, maternal vitamin A or beta-carotene supplementation trial in Bangladesh: design and methods. Trials 2012, 12:102. BioMed Central Full Text
• [14]Bangladesh Bureau of Statistics 2011 population & housing census: preliminary results. Dhaka, Bangladesh; 2011.
• [15]World Health Organization: Integrated management of pregnancy and childbirth: a guide for essential practice. World Health Organization, Geneva; 2009.
• [16]World Health Organization: Monitoring emergency obstetric care: a handbook. WHO, Geneva; 2009.
• [17]Sikder SS, Labrique AB, Shamim AA, Ali H, Mehra S, Wu L, et al.: Risk factors for reported obstetric complications and near misses in rural northwest Bangladesh: Analysis from a prospective cohort study. BMC Pregnancy Childbirth 2014, 14:347. BioMed Central Full Text
• [18]West KP Jr, Shamim AA, Labrique AB, Ali H, Shaikh S, Mehra S, et al.: Efficacy of antenatal multiple micronutrient vs iron-folic acid supplementation in improving gestational and postnatal viability in rural Bangladesh: the JiVitA-3 trial. FASEB J 2013, 27:358.6.
• [19]Averting Maternal Death and Disability: Emergency obstetric care assessment toolkits. Columbia University, New York; 2010.
• [20]Paxton A, Bailey P, Lobis S, Fry D: Global patterns in availability of emergency obstetric care. Int J Gynaecol Obstet 2006, 93:300-7.
• [21]Stata Corp LP: Stata Statistical Software: Release 11. StataCorp LP, College Station, TX; 2009.
• [22]Atlas.ti: Atlas.ti Scientific Software Development GmbH. Atlas.ti, Berlin, Germany; 2011.
• [23]Environmental Systems Research Institute (ESRI): ArcGIS Desktop Release 10. ESRI, Redlands, CA; 2011.
• [24]Sandhani Donor Club: Gaibandha Branch. Sandhani annual report. Sandhani, Gaibandha, Bangladesh; 2010.
• [25]Berendes S, Heywood P, Oliver S, Garner P: Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies. PLoS Med 2011, 8:e1000433.
• [26]Bangladesh Bank: Exchange rate. Bangladesh Bank, Dhaka, Bangladesh; 2015.
• [27]BRAC (Building Resources Across Communities): 2011 annual report. BRAC, Dhaka, Bangladesh; 2012.
• [28]Chowdhury JH, Sultana S, Chowdhury R, Sultana T, Hasan M: Health facility assessment in Habiganj District under MaMoni project. Dhaka, Bangladesh; 2011.
• [29]Fujioka A, Smith J: Prevention and management of postpartum hemorrhage and pre-eclampsia/eclampsia: national programs in selected USAID program-supported countries. Washington, DC; 2011.
• [30]Force MHT: Global Health Visions: UN commission on life saving commodities for women and children: country case studies. Washington, DC; 2012.
• [31]Collin SM, Anwar I, Ronsmans C: A decade of inequality in maternity care: antenatal care, professional attendance at delivery, and caesarean section in Bangladesh (1991–2004). Int J Equity Health 2007, 6:9. BioMed Central Full Text
• [32]Khan MM, Kramer A, Khandoker A, Prufer-Kramer L, Islam A: Trends in sociodemographic and health-related indicators in Bangladesh, 1993–2007: will inequities persist? Bull World Health Organ 2011, 89:583-93.
• [33]National Institute of Population Research and Training (NIPORT), Mitra and Associates, Macro International: Bangladesh demographic and health survey 2007. Macro International, Dhaka, Bangladesh and Calverton, Maryland, USA; 2009.
• [34]Lehmann U, Dieleman M, Martineau T: Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res 2008, 8:19. BioMed Central Full Text
• [35]Adkoli BV: Migration of health workers: perspectives from Bangladesh. India, Nepal, Pakistan, and Sri Lanka. Presentation WHO South-East Asia Regional Forum; 2006.
• [36]Wibulpolprasert S, Pengpaibon P: Integrated strategies to tackle the inequitable distribution of doctors in Thailand: four decades of experience. Hum Resour Health 2003, 1:12. BioMed Central Full Text
• [37]Islam MB: Blood transfusion services in Bangladesh. Asian J Transfus Sci 2009, 3:108-10.
• [38]Githinji S, Kigen S, Memusi D, Nyandigisi A, Mbithi AM, Wamari A, et al.: Reducing stock-outs of life saving malaria commodities using mobile phone text-messaging: SMS for life study in Kenya. PLoS One 2013, 8:e54066.