Abstract
Objectives Vital to implementation of the World Health Organization (WHO) Safe Childbirth Checklist (SCC), designed to improve delivery of 28 essential birth practices (EBPs), is the availability of safe birth supplies: 22 EBPs on the SCC require one or more supplies. Mapping availability of these supplies can determine the scope of shortages and need for supply chain strengthening. Methods A cross-sectional survey on the availability of functional and/or unexpired supplies was assessed in 284 public-sector facilities in 38 districts in Uttar Pradesh, India. The twenty-three supplies were categorized into three non-mutually exclusive groups: maternal (8), newborn (9), and infection control (6). Proportions and mean number of supplies available were calculated; means were compared across facility types using t-tests and across districts using a one-way ANOVA. Log-linear regression was used to evaluate facility characteristics associated with supply availability. Results Across 284 sites, an average of 16.9 (73.5%) of 23 basic childbirth supplies were available: 63.4% of maternal supplies, 79.1% of newborn supplies, and 78.7% of infection control supplies. No facility had all 23 supplies available and only 8.5% had all four medicines assessed. Significant variability was observed by facility type and district. In the linear model, facility type and distance from district hospital were significant predictors of higher supply availability. Conclusions for Practice In Uttar Pradesh, more remote sites, and primary and community health centers, were at higher risk of supply shortages. Supply chain management must be improved for facility-based delivery and quality of care initiatives to reduce maternal and neonatal harm.
Highlights
Despite global progress, maternal and neonatal mortality rates remain high
Lower level facilities and some districts are severely under supplied in Uttar Pradesh, which may be due to gaps in the supply chain or poor management at the facility or district level
None of the 85 primary health centers (PHCs) reported performing a cesarean delivery in the last year, while 3.65% of community health centers (CHCs) and 80% of CHC/first referral units (CHC/FRU) reported at least one cesarean delivery in the last year (Table 2)
Summary
Maternal and neonatal mortality rates remain high. India has experienced improvements in both rates; Uttar Pradesh, India’s most populous state, has death rates well above the country averages. In 2005, the Government of India implemented the conditional-cash transfer program called Janani Suraksha Yojana (JSY), promoting institutional delivery among women of lower socio-economic status. JSY provides direct cash payment to the mother as well the community health worker that supports care during and post-delivery (Janani Suraksha Yojana (JSY)|National Health Portal of India 2015). JSY has been associated with increased facility-based deliveries, vaccination rates, post-partum checkups, and breastfeeding around the time of delivery (Carvalho et al 2014). The increase in facilitybased delivery has not been associated with a significant reduction in MMR and NMR. This may be an indication of poor quality care. Understanding the reasons behind poor quality of care is essential to addressing the problem
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