Linking household and health facility surveys to assess obstetric service availability, readiness and coverage

Evidence from 17 low- and middle-income countries

Dados Bibliográficos

ID19552682
AutoresMufaro Kanyangarara (0000-0002-1367-1546, Johns Hopkins University), Victoria B Chou (0000-0003-3215-5544, Johns Hopkins University), Andreea A Creanga (0000-0001-5171-006X, Johns Hopkins University), Neff Walker (0000-0003-3526-2978, Johns Hopkins University)
Ano2018
Volume8
Fascículo1
Páginas010603-010603
Data de publicação2018-06-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoJournal of Global Health (JOURNAL)
Identificadores do periódicoISSN: 2047-2978 • E-ISSN: 2047-2986
EditoraInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.08.010603
PMID29862026
OpenAlexW2804184194
IdiomaEN
Citações recebidas15
Referências citadas29

BACKGROUND: Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. METHODS: We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. RESULTS: Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric services" (≥30% of facility deliveries) were only found in three countries. CONCLUSIONS: The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care

Business · Developing country · Economic growth · Economics · Environmental health · Health facility · Health services · High income countries · Low and middle income countries · Low income · MEDLINE · Political science · Population · Socioeconomics · Global Health and Surgery · Global Maternal and Child Health · Maternal and Perinatal Health Interventions · Medicine · Marketing