Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

Ashish Kc,Mats Målqvist,Madan Kumar Upadhyaya,Shyam Sundar Budhathoki,Dipendra Raman Singh,Abhishek Gurung

doi:10.1007/s10995-019-02846-w

Abstract

IntroductionNepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.MethodsData were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.ResultsOf the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.ConclusionsThese findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

Highlights

Nepal has pledged to substantially reduce maternal and newborn death by 2030
The Nepal Health Facility Survey (NHFS) is representative for different facility types [public hospitals, primary health care centres (PHCCs), health posts, urban health centres (UHCs), HIV testing and counselling sites (HTC), and private hospitals], for different managing authorities, and for each of Nepal’s six administrative regions and three ecological regions [mountain, hills and plains]
Among the government hospitals providing delivery and newborn services, more than 90% of them had delivery bed, blank partogram, thermometer, fetal stethoscope or pinard, blood pressure apparatus, and baby weighing machine and 80% of them had bag-and-mask devices for neonatal resuscitation

Summary

Introduction

Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal. The ENAP and Strategies for Ending Preventable Maternal Mortality (EPMM), aim to reduce preventable maternal and newborn deaths and stillbirths by 2030 across the Sustainable Development Goal (SDG) period (World Health Organization and UNICEF 2014; World Health Organization 2015). This can only be realized by improving QoC during pregnancy, intrapartum and postpartum periods (United Nations 2015, 2016; Boerma et al 2018). Further reductions in maternal mortality require improved QoC for MNH (Kruk et al 2016; Persson 2017)

Methods

Results

Conclusion