Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Abstract

Background: Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods: Using an audit tool and interviews, respectively, facility readiness and health providers' knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. Results: Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. Conclusions: Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Among studies included in the review, a majority was from India (n=30, 48 %) . There were 11 studies from Nepal (42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52) , 10 from Bangladesh (53)(54)(55)(56)(57)(58)(59)(60)(61)(62) , six from Indonesia (63)(64)(65)(66)(67)(68) and two from Timor-Leste 69,70 . From Bhutan 71 , Thailand 72 , and Myanmar 73 one from each was identi ed.…”

“…When considering the quality of MCH care, facility readiness was detected as poor for emergency obstetric care and newborn care in public and private health facilities including primary care facilities both rural and urban areas in India, Nepal and Bangladesh 21,31,47,56 . Several studies detected inadequate infrastructure leads to poor quality in maternal and child care including family planning services in the region 12,[22][23][24]26,28,38,45,51,52,56,60,65,73 .…”

“…Inadequate healthcare workers including specialists was identi ed as a challenge for provision of better maternal and neonatal care in India, Nepal, Bangladesh, Indonesia, Timor-Leste and Myanmar 12,22,24,26,29,8,45,47,49,51,56,61,63,69,73 . Shortage of staff is widespread in rural areas.…”

“…Suboptimal knowledge and skills among workers in the eld leads to poor quality MCH 22,35,47,65,68 . Few social, professional and economic barriers are identi ed with midwifery personnel in Bangladesh which preventing quality maternity care 53 .…”

Providing maternal health services during the COVID-19 pandemic in Nepal

“…Challenges persist in providing high quality care in health facilities. 3 Consequently, both the place of births and the place of maternal deaths have shifted from homes to health facilities in Nepal. 4…”