Need For Emergency Obstetric Care Research Articles

Improving Emergency Obstetric Care in a Context of Very High Maternal Mortality: The Nepal Safer Motherhood Project 1997–2004

The Nepal Safer Motherhood Project (1997–2004) was one of the first large-scale projects to focus on access to emergency obstetric care, covering 15% of Nepal. Six factors for success in reducing maternal mortality are applied to assess the project. There was an average annual increase of 1.3% per year in met need for emergency obstetric care, reaching 14% in public sector facilities in project districts in 2004. Infrastructure and equipment to achieve comprehensive-level care were improved, but sustained functioning, availability of a skilled doctor, blood and anaesthesia, were greater challenges. In three districts, 70% of emergency procedures were managed by nurses, with additional training. However, major shortages of skilled professionals remain. Enhancement of the weak referral system was beyond the project’s scope. Instead, it worked to increase information in the community about danger signs in pregnancy and delivery and taking prompt action. A key initiative was establishing community emergency funds for obstetric complications. Efforts were also made to develop a positive shift in attitudes towards patient-centred care. Supply-side interventions are insufficient for reducing the high level of maternal deaths. In Nepal, this situation is complicated by social norms that leave women undervalued and disempowered, especially those from lower castes and certain ethnic groups, a pattern reflected in use of maternity services. Programming also needs to address the social environment.RésuméLe projet népalais pour une maternité à moindre risque (1997–2004) a été l’un des premiers grands projets à se centrer sur l’accès aux soins obstétricaux d’urgence, couvrant 15% du Népal. Six facteurs de réduction de la mortalité maternelle ont été choisis pour évaluer le projet. La satisfaction des besoins en soins obstétricaux d’urgence a augmenté en moyenne de 1,3% par an, atteignant 14% en 2004 dans les centres publics visés par le projet. L’infrastructure et les équipements se sont améliorés, mais le fonctionnement, la disponibilité d’un médecin qualifié, de sang et d’anesthésie demeuraient problématiques. Dans trois districts, 70% des procédures d’urgence étaient pratiquées par des infirmières ayant suivi une formation complémentaire. Néanmoins, les professionnels qualifiés continuent de manquer cruellement. L’amélioration du système d’aiguillage n’entrait pas dans le champ du projet qui a préféré apprendre à la communauté à reconnaître les signes de danger pendant la grossesse et l’accouchement et à y réagir rapidement. La création de fonds communautaires pour les complications obstétricales constitue une initiative clé. Le projet a également encouragé un changement de comportement en faveur de soins à l’écoute des patientes. Les interventions centrées sur l’offre ne suffisent pas à réduire le niveau élevé de décès maternels. Au Népal, cette situation est compliquée par des normes sociales défavorables aux femmes – particulièrement quant elles appartiennent à des castes inférieures ou à certains groupes ethniques – qui se reflètent dans beaucoup de services de maternité. La programmation doit aussi agir sur l’environnement social.ResumenEl proyecto de Maternidad más segura (1997–2004), en Nepal, fue uno de los primeros proyectos de gran escala que se centró en el acceso a los cuidados obstétricos de emergencia, y abarcó el 15% de Nepal. A fin de evaluar el proyecto se aplican seis factores para lograr disminuir la tasa de mortalidad materna. En 2004, hubo un aumento anual promedio de un 1.3% para cubrir la necesidad de cuidados obstétricos de emergencia, y se alcanzó el 14% en establecimientos del sector público, en distritos del proyecto. Se mejoraron la infraestructura y el equipo para lograr el nivel de atención integral, pero resultó más difícil lograr funcionamiento continuo, así como disponibilidad de un médico calificado, sangre y anestesia. En tres distritos, el 70% de los procedimientos de emergencia eran manejados por enfermeras, con capacitación adicional. Sin embargo, aún existe una gran escasez de profesionales calificados. Quedó fuera del alcance del proyecto mejorar el sistema de referencia deficiente. En vez, se trabajó para aumentar la información de la comunidad respecto a los signos de alarma del embarazo y el parto, y la toma de medidas con prontitud. Una iniciativa importante fue establecer fondos comunitarios de emergencia para complicaciones obstétricas. Además, se realizaron esfuerzos por fomentar un cambio positivo en actitudes hacia la atención centrada en la paciente. Las intervenciones relacionadas con los suministros son insuficientes para disminuir el alto índice de muertes maternas. En Nepal, esta situación se complica por las normas sociales que dejan a las mujeres subvaloradas y sin poder, especialmente aquéllas de clases más bajas y determinados grupos étnicos, un patrón reflejado en el uso de los servicios de maternidad. Los programas deben tener en cuenta el ambiente social.

Strengthening emergency obstetric care in Ayacucho, Peru

Objective With support from the Averting Maternal Death and Disability (AMDD) Program, CARE began the FEMME Project in 2000 to increase access and utilization of emergency obstetric care (EmOC) services for the approximately 48,000 pregnant women in the northern provinces of Ayacucho. Methods The project targeted 5 facilities with a comprehensive package of interventions designed to improve capacity to provide quality EmOC services and to promote a human rights approach in health care. Key program activities included improvements in infrastructure, human resources capacity development, development of service standards and protocols, quality improvement activities, and promoting a rights-based approach to health. Results By the end of the project, northern Ayacucho had 6 functioning EmOC facilities: 3 comprehensive (including a non-FEMME project facility) and 3 basic. This exceeds the UN minimum recommendation of 5 EmOC facilities per 500,000 population. Other changes in the UN process indicators indicate an increase in quality and utilization of EmOC services. Met need for EmOC increased significantly from 30% in 2000 to a high of 84% in 2004. Case fatality rates declined and the number of maternal deaths in the entire region declined. Conclusion CARE's work in Ayacucho made an impact on policies and programs related to EmOC throughout the region. Within CARE, project experiences have supported maternal health programs particularly in the Latin American/Caribbean region.

The FIGO Save the Mothers Initiative: The Uganda–Canada collaboration

In 1998, the ob/gyn associations of Uganda and Canada launched, under the umbrella of the FIGO Save the Mothers Initiative, a district-wide intervention which aimed to increase the availability and utilization of emergency obstetric care (EmOC) services in a rural district of Uganda. The article describes the experience of two professional ob/gyn associations in the development, implementation, monitoring and evaluation of the project. Preliminary results after 24 months of intervention indicate important gains in the capacity of health professionals to deliver EmOC, the availability of emergency transportation services and met need for EmOC.