Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

Siphiwe Bridget Pearl Thwala,Duane Blaauw,Freddie Ssengooba,Massimo Ciccozzi

doi:10.1371/journal.pone.0194576

Abstract

BackgroundImproving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio.MethodsData collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared.ResultsAll 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (p<0.001).ConclusionsThe analysis indicated a shortfall of EmNOC facilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

Highlights

Significant progress has been made to combat maternal mortality
This study presents an assessment of the preparedness of public health facilities to provide Emergency obstetric and neonatal care (EmNOC) using these methods in one South African district with a persistently high maternal mortality ratio
All 7 hospitals in the district were classified as comprehensive EmNOC (CEmNOC) facilities, but none of the 8 community health centres (CHCs) performed all required signal functions to be classified as basic EmNOC (BEmNOC) facilities

Summary

Introduction

Significant progress has been made to combat maternal mortality. From 1990 to 2015, the maternal mortality ratio (MMR) reduced by 45% globally, and by 49% in sub-Saharan Africa [1]. For the new sustainable development goals (SDGs), the world has resolved to end all preventable maternal mortality, and committed to the ambitious goal of reducing the global MMR to 70 per 100 000 live births or less, while making sure that no country has an MMR above 140, by the year 2030 [3]. Realisation of these targets requires immediate and concerted efforts [4]. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio

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