Basic emergency obstetric and newborn care service availability and readiness in Nepal: Analysis of the 2015 Nepal Health Facility Survey

Acharya, Kiran; Subedi, Raj Kumar; Dahal, Sushma; Karkee, Rajendra

doi:10.1371/journal.pone.0254561

Cited by 10 publications

(19 citation statements)

References 31 publications

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“…Factors associated with BEmONC service readiness. 1% in 2021 from 16.1% in 2015[15]. These findings also tally with the findings presented in Annual report of DoHS.…”

supporting

confidence: 91%

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Service Availability and Readiness for Basic Emergency Obstetric and Newborn Care: Analysis from Nepal Health Facility Survey 2021

Pandey¹,

Adhikari²,

Lamichhane³

et al. 2023

Preprint

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Background Although there has been significant improvement in maternal and newborn health, Nepal needs further acceleration in improving access to and coverage of services to achieve Sustainable Development Goals by 2030. In this context, we aimed to analyze availability and readiness for Basic Emergency Obstetric and Neonatal Care (BEmONC) services in Nepal using data from Nepal Health Facility Survey (NHFS), 2021. Methods We analyzed nationally representative NHFS, 2021 data to determine availability and readiness of HFs for BEmONC services based on the “Service Availability and Readiness” manual of World Health Organizations. We performed weighted descriptive and inferential analysis to account complex survey design of NHFS 2021. We summarized continuous variables with mean, standard deviation, median and interquartile range whereas categorical variables with percent and 95% confidence interval (CI). We applied simple, and multiple linear regression to determine factors associated with readiness of HFs for BEmONC services Results The proportion of facilities with all BEmONC signal function available was 2.49% at the national level with Madhesh having the highest (5.22%) while Gandaki having the lowest (1.22%) availability. BEmONC service availability was relatively lower in rural setting and peripheral facilities. The overall readiness score for BEmONC services is 54.14, with domains of guidelines/staff, equipment/supplies, and medicines/commodities having scores of 21.16, 76.76, and 64.50 respectively. In multivariable analysis, level of facilities, province, urban rural setting, ecological belt, presence of external supervision, 24-hour duty schedule and number of beds were found to have statistically significant association with BEmONC service readiness. Conclusion The readiness of HFs for BEmONC services in Nepal is relatively poor and can be improved by increasing service provision, expanding service hours to 24-hours a day, increasing availability of essential medicines and equipment, enhanced monitoring, and conducting periodic review of maternal and newborn deaths at HFs.

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“…Factors associated with BEmONC service readiness. 1% in 2021 from 16.1% in 2015[15]. These findings also tally with the findings presented in Annual report of DoHS.…”

supporting

confidence: 91%

“…Facilities in Bagmati Province had higher BEmONC service readiness score (by 3.37 points, p-value=0.034). Unlike previous study [15], the BEmONC service readiness was better in rural area ( 2.76 points, p-value=0.008) which could be because higher proportion of health workers in rural area have been trained on BEmONC related services [12].…”

Section: Resultsmentioning

confidence: 60%

Service Availability and Readiness for Basic Emergency Obstetric and Newborn Care: Analysis from Nepal Health Facility Survey 2021

Pandey¹,

Adhikari²,

Lamichhane³

et al. 2023

Preprint

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“…In contrast, health facilities of Karnali province had poor structural quality PLOS GLOBAL PUBLIC HEALTH perinatal services, which are likely to result in poor quality MNH services. These findings resonate with available evidence; for instance, past studies suggest that peripheral health facilities were poorly prepared for quality primary health services in Nepal [30][31][32], India [63], and Burkina Faso [64]. This is of concern as peripheral health facilities provide most routine ANC, childbirth PNC services [60].…”

Section: Plos Global Public Healthsupporting

confidence: 73%

“…Based on the information available in the dataset and previous studies [30][31][32], seven health facility level independent variables were selected, such as managing authority (Private, Public), facility types, provinces (province 1 -not named yet), Madhesh, Bagmati, Gandaki, Lumbini, Karnali, Sudurpaschim), mechanism of quality assurance (Yes, No), frequency of health facilities' management meeting (No, Sometimes, and Monthly), the existence of feedback collection system in health facilities (Yes, No), availability of external supervision of staff (Yes, No). In addition, Routine quality assurance activity was coded as "yes" for facilities reporting that it routinely carries out quality assurance activities (documentation of report or minutes of a quality assurance meeting, a supervisory checklist, a mortality review, or an audit of records or registers) and "No" for those without such quality assurance activities [28].…”

Section: Independent Variablesmentioning

confidence: 99%

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Khatri

Assefa

Durham

2022

PLOS Glob Public Health

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Access to and utilisation of routine maternal and newborn health (MNH) services, such as antenatal care (ANC), and perinatal services, has increased over the last two decades in Nepal. The availability, delivery, and utilisation of quality health services during routine MNH visits can significantly impact the survival of mothers and newborns. Capacity of health facility is critical for the delivery of quality health services. However, little is known about health system readiness (structural quality) of health facilities for routine MNH services and associated determinants in Nepal. Data were derived from the Nepal Health Facility Survey (NHFS) 2015. Total of 901 health facilities were assessed for structural quality of ANC services, and 454 health facilities were assessed for perinatal services. Adapting the World Health Organization’s Service Availability and Readiness Assessment manual, we estimated structural quality scores of health facilities for MNH services based on the availability and readiness of related subdomain-specific items. Several health facility-level characteristics were considered as independent variables. Logistic regression analyses were conducted, and the odds ratio (OR) was reported with 95% confidence intervals (CIs). The significance level was set at p-value of <0.05. The mean score of the structural quality of health facilities for ANC, and perinatal services was 0.62, and 0.67, respectively. The average score for the availability of staff (e.g., training) and guidelines-related items in health facilities was the lowest (0.37) compared to other four subdomains. The odds of optimal structural quality of health facilities for ANC services were higher in private health facilities (adjusted odds ratio (aOR) = 2.65, 95% CI: 1.48, 4.74), and health facilities supervised by higher authority (aOR = 1.96; CI: 1.22, 3.13) while peripheral health facilities had lower odds (aOR = 0.13; CI: 0.09, 0.18) compared to their reference groups. Private facilities were more likely (aOR = 1.69; CI:1.25, 3.40) to have optimal structural quality for perinatal services. Health facilities of Karnali (aOR = 0.29; CI: 0.09, 0.99) and peripheral areas had less likelihood (aOR = 0.16; CI: 0.10, 0.27) to have optimal structural quality for perinatal services. Provincial and local governments should focus on improving the health system readiness in peripheral and public facilities to deliver quality MNH services. Provision of trained staff and guidelines, and supply of laboratory equipment in health facilities could potentially equip facilities for optimal quality health services delivery. In addition, supervision of health staff and facilities and onsite coaching at peripheral areas from higher-level authorities could improve the health management functions and technical capacity for delivering quality MNH services. Local governments can prioritise inputs, including providing a trained workforce, supplying equipment for laboratory services, and essential medicine to improve the quality of MNH services in their catchment.

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“…We created a new independent variable, i.e., health facility capacity, which refers to the structural or input quality of a facility that provides a specific service. Studies reported that better input quality/ capacity of facilities could deliver better technical quality health services [29,[57][58][59][60]. Health facility capacity was created by conducting Principal Component Analysis (PCA) to generate composite-scale coefficients to reduce indicators to indices for application in comparative analyses of health facility readiness [61].…”

Section: Study Variablesmentioning

confidence: 99%

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

2022

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Background Access to routine antenatal and perinatal services is improved in the last two decades in Nepal. However, gaps remain in coverage and quality of care delivered from the health facilities. This study investigated the delivery of technical quality antenatal and perinatal services from health facilities and their associated determinants in Nepal. Methods Data for this study were derived from the Nepal Health Facility Survey 2015. The World Health Organization's Service Availability and Readiness Assessment framework was adopted to assess the technical quality of antenatal and perinatal services of health facilities. Outcome variables included technical quality scores of i) 269 facilities providing antenatal services and ii) 109 facilities providing childbirth and postnatal care services (perinatal care). Technical quality scores of health facilities were estimated adapting recommended antenatal and perinatal interventions. Independent variables included locations and types of health facilities and their management functions (e.g., supervision). We conducted a linear regression analysis to identify the determinants of better technical quality of health services in health facilities. Beta coefficients were exponentiated into odds ratios (ORs) and reported with 95% confidence intervals (CIs). The significance level was set at p-value < 0.05. Results The mean score of the technical quality of health facilities for each outcome variable (antenatal and perinatal services) was 0.55 (out of 1.00). Compared to province one, facilities of Madhesh province had 4% lower odds (adjusted OR = 0.96; 95%CI: 0.92, 0.99) of providing better quality antenatal services, while health facilities of Gandaki province had higher odds of providing better quality antenatal services (aOR = 1.05; 95% CI: 1.01, 1.10). Private facilities had higher odds (aOR = 1.13; 95% CI: 1.03, 1.23) of providing better quality perinatal services compared to public facilities. Conclusions Private facilities provide better quality antenatal and perinatal health services than public facilities, while health facilities of Madhesh province provide poor quality perinatal services. Health system needs to implement tailored strategies, including recruiting health workers, supervision and onsite coaching and access to necessary equipment and medicine in the facilities of Madhesh province. Health system inputs (trained human resources, equipment and supplies) are needed in the public facilities. Extending the safe delivery incentive programme to the privately managed facilities could also improve access to better quality health services in Nepal.

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Basic emergency obstetric and newborn care service availability and readiness in Nepal: Analysis of the 2015 Nepal Health Facility Survey

Cited by 10 publications

References 31 publications

Service Availability and Readiness for Basic Emergency Obstetric and Newborn Care: Analysis from Nepal Health Facility Survey 2021

Service Availability and Readiness for Basic Emergency Obstetric and Newborn Care: Analysis from Nepal Health Facility Survey 2021

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

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