Abstract
BackgroundProvision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. This study aimed to describe the experience of rural health facility managers in ensuring the timely availability of drugs and medical supplies for emergency obstetric care (EmOC).MethodsIn-depth interviews were conducted with a total of 17 health facility managers: 14 from dispensaries and three from health centers. Two members of the Council Health Management Team and one member of the Council Health Service Board were also interviewed. A survey of health facilities was conducted to supplement the data. All the materials were analysed using a qualitative thematic analysis approach.ResultsParticipants reported on the unreliability of obtaining drugs and medical supplies for EmOC; this was supported by the absence of essential items observed during the facility survey. The unreliability of obtaining drugs and medical supplies was reported to result in the provision of untimely and suboptimal EmOC services. An insufficient budget for drugs from central government, lack of accountability within the supply system and a bureaucratic process of accessing the locally mobilized drug fund were reported to contribute to the current situation.ConclusionThe unreliability of obtaining drugs and medical supplies compromises the timely provision of quality EmOC. Multiple approaches should be used to address challenges within the health system that prevent access to essential drugs and supplies for maternal health. There should be a special focus on improving the governance of the drug delivery system so that it promotes the accountability of key players, transparency in the handling of information and drug funds, and the participation of key stakeholders in decision making over the allocation of locally collected drug funds.
Highlights
Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality
This study found a number of governance-related issues that affect the timely availability of essential drugs for emergency obstetric care (EmOC) at rural health facilities
Our study found that availability of essential drugs and medical supplies in rural health facilities is still a problem, a situation that could interfere with provision of quality EmOC at this level of health system [8,32,34,35,36]
Summary
Provision of quality emergency obstetric care relies upon the presence of skilled health attendants working in an environment where drugs and medical supplies are available when needed and in adequate quantity and of assured quality. The concept of emergency obstetric care (EmOC) is based on the assumption that maternal complications are unpredictable and that obstetric complications can occur in around 15% of deliveries [6,7] When such complications occur, maternal mortality could be prevented in a setting where skilled health attendants, drugs and medical supplies needed for EmOC are available [8]. The provision of obstetric care coverage has been evaluated against the presence of physical infrastructure such as number of health centers, without taking into account the actual care provided at these facilities [14,15] This could lead to the perception that the coverage of EmOC had improved theoretically, while in practice the accessibility and utilization of these facilities is limited due to shortage of drugs and medical supplies. Previous studies that have reported on drug shortages in developing countries have focused mostly on diseases such as malaria, tuberculosis and HIV/AIDS [16,17,18], and very few studies have described the effects of drug availability on maternal health care [19,20,21]
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