Are Health Facilities Ready to Provide Emergency Obstetric and Newborn Care?
NAIROBI, Kenya—Most maternal and neonatal deaths in low-income countries, including Kenya, are attributable to a handful of preventable causes. Kenya’s Ministry of Health, working closely with county governments and other partners, is committed to expanding the coverage of emergency obstetric and newborn care (EmONC) to all health facilities nationwide. EmONC is an integrated strategy that aims to equip health workers with skills, life-saving medicines, and equipment to manage the leading causes of maternal and newborn death.
In July 2013, in partnership with the U.S. Agency for International Development (USAID), the Ministry of Health embarked on a program to expand EmONC services to 15 counties spanning the country’s 10 major regions. The program began with assessments of the needs of selected facilities in 14 counties. These surveys were conducted to identify the specific changes that would be needed to expand services and to provide baseline data for purposes of monitoring and evaluation—to be able to tell what works.
In 2014, county teams, with support from USAID-funded APHIAplus partners, the Maternal and Child Survival Project (MCSP) and AMPATH PLUS, explored the EmONC needs further, focusing on the 13 Kenyan counties with the highest maternal and neonatal mortality rates. The research teams studied the preparedness of 376 health facilities (278 health centers and dispensaries and 98 hospitals) to provide emergency obstetric and newborn care. From July 2014 to August 2014 they collected data in selected facilities on the number of EmONC-trained health workers and the availability of equipment and medicines required to provide key services. MEASURE Evaluation PIMA, a USAID-funded project focused on data for health decision making, then analyzed the research findings and disseminated them to county teams. Those teams then developed action plans.
What did they find? On average, only 2 percent of health centers and dispensaries across the 13 counties had the essential supplies required to provide all key EmONC functions. In comparison, about a third of the hospitals had all the supplies required to provide these functions—such as oxytocin, a drug used to control bleeding during obstetric emergencies.
In addition, the number of health workers in the maternity and newborn departments who had received training in EmONC in the 12 months preceding the survey was low, ranging between 10 percent and 30 percent in most counties. Guidelines on quality emergency obstetric and neonatal care were available in most hospitals but absent in many health centers and dispensaries.
"The majority of these health facilities lack essential equipment and the commodities required to provide this type of emergency services to pregnant women and newborn infants,” says Amin Abdinasir, Chief of Party at MEASURE Evaluation PIMA. “The government is committed to ensuring universal access to high-quality maternal and newborn care in health facilities across the country. The findings of the EmONC assessment have been used to develop county and facility action plans. Having the data to determine areas of greatest need will help us focus efforts to improve health services.”
Why do women die?
Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. The major complications that account for nearly 75% of all maternal deaths are:
The remainder are caused by or associated with diseases such as malaria and AIDS during pregnancy.
Reprinted from: World Health Organization. 2015. Maternal mortality: Fact sheet N°348. Geneva: World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs348/en/
For more information
Ending preventable child and maternal deaths is one of USAID’s global health priorities. The agency has made substantial investments to achieve this goal, including supporting the delivery of a core package of high-quality reproductive maternal, newborn, and child health interventions that provide a continuum of care to mothers, newborns and children. Through projects such as MEASURE Evaluation PIMA, USAID also supports the Ministry of Health and county governments to monitor trends and performance of maternal newborn and child health outcomes and strengthen use of data at the national and county levels. Read more at: http://www.cpc.unc.edu/measure/pima. To download a copy of the EmONC assessment report, see: http://www.cpc.unc.edu/measure/resources/publications/tr-16-123.