Abstract
BackgroundOver the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services.MethodsA descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures.ResultsOut ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns.ConclusionHFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.
Highlights
Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival
The questionnaire contained information relating to the provision of care and facility readiness such as health service delivery, maternal and newborn care services, infrastructure such as water and electricity, availability of skilled health workers, access to essential medicines and a health information system since they are a critical part of the strengthening health system. (A copy of the questionnaire is available from the first author)
The remaining six health posts were in the process of being upgraded to birthing centres (BC)
Summary
Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival. Improving the quality of health services is a key strategy to achieve the United Nations (UN) Sustainable Development Goal 3 (SDG3) to be achieved by 2030 [16] To achieve this aim, “quality health care must be safe, effective, timely, efficient, equitable and people-centered” [23]. Relevant to the maternal and newborn health services are three SDG targets: 3.1 “reduce the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births”; 3.2 “end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births”; and 3.8 “Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all” [20]. Low- and middle-income countries (LMIC), in particular, face considerable challenges in providing quality, affordable and universally accessible maternal and neo-natal care [10]
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