Abstract
BackgroundIndia has experienced a steep rise in institutional childbirth. The relative contributions of public and private sector facilities to emergency obstetric care (EmOC) has not been studied in this setting. This paper aims to study in three districts of Gujarat state, India:(a) the availability of EmOC facilities in the public and private sectors; (b) the availability and distribution of human resources for birth attendance in the two sectors; and (c) to benchmark the above against 2005 World Health Report benchmarks (WHR2005).MethodsA cross-sectional survey of obstetric care facilities reporting 30 or more births in the last three months was conducted (n = 159). Performance of EmOC signal functions and availability of human resources were assessed.ResultsEmOC provision was dominated by private facilities (112/159) which were located mainly in district headquarters or small urban towns. The number of basic and comprehensive EmOC facilities was below WHR2005 benchmarks. A high number of private facilities performed C-sections but not all basic signal functions (72/159). Public facilities were the main EmOC providers in rural areas and 40/47 functioned at less than basic EmOC level. The rate of obstetricians per 1000 births was higher in the private sector.ConclusionsThe private sector is the dominant EmOC provider in the state. Given the highly skewed distribution of facilities and resources in the private sector, state led partnerships with the private sector so that all women in the state receive care is important alongside strengthening the public sector.
Highlights
India has experienced a steep rise in institutional childbirth
Overall emergency obstetric care (EmOC) availability EmOC provision in the three districts under study was dominated by private facilities (70.4 %, 112/159) (Table 2). 22 % (35/159) of all facilities providing childbirth care were located in rural areas while the rest were located in district headquarters or small urban towns
We have used the World Health Report (WHR) 2005 benchmarks and we found that the numbers of basic EmOC (BEmOC) and comprehensive EmOC (CEmOC) facilities were below these benchmarks [8], with the largest gap in BEmOC facilities
Summary
India has experienced a steep rise in institutional childbirth. The relative contributions of public and private sector facilities to emergency obstetric care (EmOC) has not been studied in this setting. This paper aims to study in three districts of Gujarat state, India:(a) the availability of EmOC facilities in the public and private sectors; (b) the availability and distribution of human resources for birth attendance in the two sectors; and (c) to benchmark the above against 2005 World Health Report benchmarks (WHR2005). Despite the sharp rise in facility births, and the contribution of the private sector to this, there are no reports studying the availability of EmOC in the state and the relative contributions of public and private sector facilities to this care. We look at the availability and distribution of human resources for birth attendance in the public and private sectors. We assess the availability of EmOC and human resources for its provision against 2005 World Health Report [8] benchmarks
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