Abstract
BackgroundIn Bangladesh, while the infrastructure of public health facilities to provide maternal and newborn care services is adequate, services are not always available due to insufficient staffing. A human resource availability index for health facilities is needed for monitoring and advocacy. This study aimed to develop indices for measuring the availability of different types of human resources to provide round-the-clock emergency obstetric and newborn care (EmONC) service at district-level public facilities.MethodsAs part of a larger intervention study, 30 days of prospective observation of providers was done at a district hospital (DH) and a mother and child welfare centre (MCWC) in one district of Bangladesh using checklists. A scoring system was developed to create an index to quantify the availability of providers for maternal and newborn care.ResultsBased on the newly developed index, medical doctors in the emergency department of the DH were 100% available, but ranged from 27 to 41% availability in the obstetrics/gynecology (ob/gyn) and pediatric wards. In MCWC, the corresponding indices ranged from 32 to 36%. In the DH, the availability of nurses in the ob/gyn ward (96%) was relatively better than in the pediatric ward (65%) but that in operation theatre was only 31%. In the MCWC, the index for the presence of a paramedic or nursing aid was 82% in the ob/gyn ward and 63% in the operation theatre. However, the availability scores of facility support staff for maintenance and security were generally high (over 90%) in both facilities.ConclusionsOur newly developed index on availability of providers demonstrated huge gaps in availability of providers in evening and night shifts in most of the disciplines in the study facilities. This provider availability index is easy to create and can be used as a meaningful tool to quantify gaps in human resources by type in various types of district-level health facilities. Further studies are needed for adaptation of this tool in different types of health facilities and to assess its implication as an advocacy tool.
Highlights
In Bangladesh, while the infrastructure of public health facilities to provide maternal and newborn care services is adequate, services are not always available due to insufficient staffing
Bangladesh has made substantial progress in reduction of maternal mortality from 569 per 100,000 live births in 1990 to an estimated 176 per 100,000 live births in 2015 [1]. This reduction is due to a substantial increase in facility-based deliveries that enables effective management of obstetric complications [2]. Though this achievement has been obtained despite many weaknesses in the Bangladesh health system, further system strengthening is warranted to achieve the sustainable development goal (SDG) target to reduce the maternal mortality ratio below 80 per 100,000 live births by 2030 [3]
The current study developed a human resource availability index for staff needed to ensure 24 h emergency obstetric and newborn care (EmONC), accounting for multiple types of providers at district level public health facilities in Bangladesh
Summary
In Bangladesh, while the infrastructure of public health facilities to provide maternal and newborn care services is adequate, services are not always available due to insufficient staffing. Bangladesh has made substantial progress in reduction of maternal mortality from 569 per 100,000 live births in 1990 to an estimated 176 per 100,000 live births in 2015 [1] This reduction is due to a substantial increase in facility-based deliveries that enables effective management of obstetric complications [2]. Though this achievement has been obtained despite many weaknesses in the Bangladesh health system, further system strengthening is warranted to achieve the sustainable development goal (SDG) target to reduce the maternal mortality ratio below 80 per 100,000 live births by 2030 [3]. There is a major shortage of nurses and paramedics to provide basic emergency obstetric and other MNH care services [6]
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