Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us? Koye...
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Transcript of Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us? Koye...
Delivery of Maternal and Newborn Care Services in Africa: What are the facilities telling us?
Koye Oyerinde MD, MPH, FAAPSymposium on Maternal Mortality, Dakar
The Averting Maternal Death and Disability Program - AMDD• Mailman School of Public Health, Columbia
University, New York City. • Help to strengthen heath systems to provide
emergency care for all women experiencing life-threatening obstetric complications.
• Conduct research and policy analysis, provide technical expertise, and advocate for solutions
• Collaborate with global, regional, and local institutions – including NGOs & academic centers
The Alliance• Memorandum of Understanding signed June
2008 between UNICEF, UNFPA, AMDD
• Alliance supports country plans for the strengthening of EmONC service delivery as a strategy for attaining MDGs 4 and 5.
• WHO collaborates on alliance activities at country and regional level.
Needs Assessment Overview• The EmONC Needs Assessments are facility
based cross-sectional studies of the capacity of a health system to provide health services to mothers and newborns
• Main focus – health system.▫ Accessibility/Coverage/Equity▫ 24 hour services▫ Human Resources▫ Equipment and Supplies▫ Infrastructure▫ Aspects of quality of care
EmONC Needs Assessments Completed – pre-2005 and/or sub-nationalCompleted – post-2005 and nationalOngoingPlanned
Current as of December 2010
The Needs Assessment Process
• Conducting the Needs Assessment
Phase I: Advocacy and
Planning
Phase II: Conducting the
Needs Assessment
Phase III: From Data to Action
The AMDD team:
• provides customized technical support and training through these phases
• works remotely and in-country to support the MOH to conduct the assessments.
Low no. of facilities offering EmONC signal functions
Coverage is defined as available EmONC facilities as a percentage of recommended EmONC facilities. There may be further disparities between urban and rural areas.
The recommended number of EmONC facilities is 5 per 500,000, at least one of which is Comprehensive (CEmONC).
Low no. of EmONC facilities Better CEmOC coverage than BEmOC
coverage But CEmOC requires BEmOC to function
properly BEmOC – 4 per 500,000 CEmOC – 1 per 500,000
Actual Recomm. Coverage Actual Recomm. Coverage
Ethiopia 25 591 4% 58 148 39%
Madagascar 3 155 2% 19 39 49%
Sierra Leone 0 48 0% 14 12 120%
Low utilization•Institutional delivery rate: •Variety within and among countries:
▫ Ethiopia 7%, ▫ Madagascar 19%▫ Sierra Leone 10%▫ Higher rates in urban areas
• Met need: % of expected
complications that are treated in EmOC facilities. Target: 100%
Missing signal functions• MVA and AVD are most commonly missing SFs,
especially at the health center level.
Sierra Leone, 2008: Proportion of hospitals and CHCs by signal functions performed in last 3 months
Low HR availability• Sierra Leone: TBAs and MCH aides conduct most deliveries, especially in health centers. SL has started new
midwifery education programs since the NA
• Madagascar: has 99 obstetricians, needs 72 more to reach norms.
• Ethiopia: only 35% of the midwives targeted in HSDP III 2010 had been trained, 26% of medical doctors, and 16% of the health officers.
Ethiopia: % of HCs staffed with at least 2 midwives and 1 health officer, by region
Inadequate commodities and supplies
Percentages of facilities with:
Misoprostol Mag Sulph Contraceptives
Ethiopia7% use for obstetric
indications
3% use as parenteral
anticonvulsant
90% have at least 3 methods
Madagascar11% (but 0% use for MVA)
0.68% use as parenteral
anticonvulsant
95% have oral contraceptives
Sierra Leone 21% 64% No info
Stock outsEthiopia: causes of delay of supplies in
hospitals
‘stock out atcentral store’ (41%)
‘financial problems’ (26%)
‘administrative difficulties’ (15%)
Madagascar: 73% of hospitals and 65% of health centers had not had a stock out of oxytocin, ergometrine, or atropine in the 12 months before the study.
Limited data collection•HMIS indicators
▫Often important indicators are not collected▫When collected the data are unused for
planning▫HMIS data often considered unreliable
A common outcome of the Needs Assessment is HMIS revision.
•Data collection at front-lines▫Facility registers often unclear and
incomplete ▫51% of health centers in Ethiopia had drug
and inventory registers
Fee for Service• Fees are often considered a barrier, especially for the
poorest.
• “Some women when told to go to the hospital would not because they do not have money; so they have problems during delivery” - Sierra Leone Needs Assessment, qualitative data:
• Sierra Leone made health services for pregnant and lactating mothers and children under 5 free in spring 2010▫ Initial reports suggest a phenomenal increase in
utilization; thus raising concerns for potential fall in quality of care
Socio-cultural barriers
•NA results are made more meaningful when combined with social science research
•Socio-cultural barriers – including abusive / disrespectful care - have been shown to delay utilization and limit benefits derived from the health system
Conclusion
•Needs Assessments have potential to surface gaps and indicate ways forward
•A systems science/health systems perspective is critical – we need strong health systems to support women during labor.
Conclusion
•Health facilities in Africa are saying:
▫Not enough, not the right type and not in the right place
▫Not adequately staffed, not with the right skills
▫Not adequately stocked, not with the right tools, drugs, and supplies