Abstract
BackgroundSignal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh.MethodsAn assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district.ResultsCaesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities.ConclusionsIn the public sector, CS delivery and BT services were available in the minimum required number of facilities. However, to ensure basic EmONC services, participation of the private sector is necessary. Public-private partnership should be promoted for nationwide coverage of signal functions for EmONC in Bangladesh.
Highlights
More than half of the maternal deaths result from haemorrhage, hypertensive disorders, and sepsis [1]
Public-private partnership should be promoted for nationwide coverage of signal functions for emergency obstetric and newborn care (EmONC) in Bangladesh
A designated comprehensive EmONC (CEmONC) facility should have nine specific signal functions, such as (i) administering parenteral antibiotics, (ii) administering uterogenic drugs for active management of the third stage of labour and prevention of postpartum haemorrhage, (iii) use of parenteral anticonvulsants for the management of pre-eclampsia/ eclampsia, (iv) manual removal of placenta, (v) removal of retained products, (vi) performing assisted vaginal delivery (AVD), i.e. vacuum extraction or forceps delivery, (vii) performing basic neonatal resuscitation), (viii) performing Caesarean section (CS) delivery, and (ix) blood transfusion (BT) services to be available for 24 hours a day, 7 days a week [3,4]
Summary
More than half of the maternal deaths result from haemorrhage, hypertensive disorders, and sepsis [1] These are preventable by a few medical interventions termed ‘signal functions’ for emergency obstetric and newborn care (EmONC) defined by the United Nations (UN) [2,3]. The major causes of maternal deaths in Bangladesh are haemorrhage and eclampsia/preeclampsia [5] that are essentially required to be managed at health facilities with relevant signal functions.
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