Access to essential technologies for safe childbirth: a survey of health workers in Africa and Asia

Jonathan M Spector,Atul A Gawande,Priya Desai,Stuart Lipsitz,Jonathan Reisman

doi:10.1186/1471-2393-13-43

Abstract

BackgroundThe reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. The majority of global maternal and newborn deaths take place in Africa and Asia, yet few data exist that describe the availability of childbirth-related health technologies in these regions. We conducted a cross-sectional survey of health workers in Africa and Asia in order to profile the availability of health technologies considered to be essential to providing safe childbirth care.MethodsHealth workers in Africa and Asia were surveyed using a web-based questionnaire. A list of essential childbirth-related health technologies was drawn from World Health Organization guidelines for preventing and managing complications associated with the major causes of maternal and newborn mortality globally. Demographic data describing each birth center were obtained and health workers reported on the availability of essential childbirth-related health technologies at their centers. Comparison analyses were conducted using Rao-Scott chi-square test statistics.ResultsHealth workers from 124 birth centers in 26 African and 15 Asian countries participated. All facilities exhibited gaps in the availability of essential childbirth-related health technologies. Availability was significantly reduced in birth centers that had lower birth volumes and those from lower income countries. On average across all centers, health workers reported the availability of 18 of 23 essential childbirth-related health technologies (79%; 95% CI, 74%, 84%). Low-volume facilities suffered severe shortages; on average, these centers reported reliable availability of 13 of 23 technologies (55%; 95% CI, 39%, 71%).ConclusionsSubstantial gaps exist in the availability of essential childbirth-related health technologies across health sector levels in Africa and Asia. Strategies that facilitate reliable access to vital health technologies in these regions are an urgent priority.

Highlights

The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality
Guidelines published by the World Health Organization (WHO) and others identify standard practices proven to promote the safety of mothers and newborns around the time of childbirth [9,10,11,18]
The childbirth-related health technologies assessed in this study were drawn directly from published WHO guidelines for managing complications associated with the major causes of maternal and neonatal mortality

Summary

Introduction

The reliable availability of health technologies, defined as equipment, medicines, and consumable supplies, is essential to ensure successful childbirth practices proven to prevent avoidable maternal and newborn mortality. Of the approximately 130 million births that take place each year, an estimated 3.3 million newborns die in the neonatal period [1], 1.2 million intrapartum-stillbirths occur [2], and nearly 350,000 mothers die from problems related to childbirth [3] Most of these deaths occur in Africa and Asia and are entirely preventable [4,5,6]. Poor availability of health technologies in smaller centers may compel patient referrals to higher level facilities This risks unnecessary delay in care since many of these patients could have been better managed if appropriate technologies were otherwise present [23]. Most lifesaving health technologies are not complex and costly but rather are simple and relatively inexpensive [19]

Methods

Results

Conclusion