Strengthening and monitoring health system's capacity to improve availability, utilization and quality of emergency obstetric care in northern Nigeria

Abstract

BackgroundQuality improvement in emergency obstetric care (EmOC) is a critical and cost-effective suite of interventions for the reduction of maternal and newborn mortality and morbidity. This study was undertaken to evaluate the impact of quality improvement interventions following a baseline assessment in Bauchi state, Nigeria.MethodsThis was a prospective before and after study between June 2012, and April 2015 in Bauchi State, Nigeria. The surveys included 21 hospitals designated by Ministry of Health (MoH) as comprehensive EmOC centers and 38 primary healthcare centers (PHCs) designated as basic EmOC centers. Data on EmOC services was collected using structured established EmOC tools developed by the Averting Maternal Death and Disability (AMDD), and analyzed using univariate and bivariate statistical analyses.ResultsFacilities providing seven or nine signal EmOC functions increased from 6 (10.2%) in 2012 to 21 (35.6%) in 2015. Basic EmOC facilities increased from 1 (2.6%) to 7 (18.4%) and comprehensive EmOC facilities rose from 3 (14.3%) to 13 (61.9%). Facility birth increased from 3.6% to 8.0%. Cesarean birth rates increased from 3.8% in 2012 to 5.6% in 2015. Met need for EmOC more than doubled from 3.3% in 2012 to 9.9% in 2015. Direct obstetric case fatality rates increased from 3.1% in 2012 to 4.0% in 2015. Major direct obstetric complications as a percent of total maternal deaths was 70.9%, down from 80.1% in 2012.ConclusionThe rise in the percent of facility-based births and in met need for EmOC suggest that interventions recommended and implemented after the baseline study resulted in increased availability, access and utilization of EmOC. Higher patient load, late arrival and better record keeping may explain the associated increase in case fatality rates.

Stakeholder Perception of the Impacts of Communication for Development in NGO-Supported Organizational Capacity Building: A Case of Yobe State Primary Health Care Management Board

“…Organizational development based on OCA is an ongoing process that optimises an organization's performance in relation to its goals, resources and environment. It addresses change within the organization itself, even when these changes are meant to help in the development of its own institutionalization (Kabo et al 2018;USAID 2012). YSPHCMB as an organization in charge of maternal and child healthcare services provision and administration needs to be aware that institutions transcend individual organizations and require different goals, strategies, time scales and tools to bring about the desired change (Breuer, Lee, De Silva, & Lund 2016;BioMed Central 2013;Booth et al 1998;Van Iddekinge 2018).…”

“…The tools and techniques adopted in this study was aimed at allowing both the capacity-building support providing NGOs (Breuer et al 2016;Ebensoa et al 2018), and YSPHCMB to identify current organizational strengths and weaknesses to establish a plan for improvement that includes mechanisms to measure change, successes and failures. Ideally, this will enable the NGOs to contribute to building the organization's capacity as a technical board involved in primary health care development program in the state (Booth et al 1998;Kabo et al 2018;YSMOH 2014). Thus, YSPHCMB will then have greater competence in, impact on, and influence over key indicators of OCA and PHC delivery in its own communities, something which is relevant to the lives of the poor and disadvantaged (Adeniyi et al 2001).…”

“…Such an assessment will allow an organization to identify where it is under-performing and where help is needed. While certain aspects of organizational functioning are common to all MDAs (e.g., competent financial accounting), there is no model template for all MDAs (Breuer et al 2016;Kabo et al 2018). The elements of a healthy organization need to be worked out for each country and perhaps for different types of MDAs (such as technical boards, community-based organizations, networks and coalitions) (Reijseger et al 2017;Van Iddekinge 2018).…”

“…This OCAT is not a 'one size fits all' kind of tool, not a panacea for all problems. It is based on a model put forward as a basis for discussion, a model whose elements need to be interpreted and corroborated (or modified) in each case with the organization under assessment (Kabo et al 2018). Experience has shown that the exercise of deciding what an ideal MDA should look like is a very important learning exercise for the MDA, as important as the subsequent exercise of assessing the organization against the model (Ebensoa et al 2018).…”

“…Leadership involves articulating and maintaining a vision and mission for the MDA which is shared by the board of directors/trustees or other oversight bodies. The board provides direction, maintains independent oversight of the management, and ensures that effective strategic planning takes place (Kabo et al 2018). The board can help to identify and procure additional resources for activities, carry out public relations and lobby the government for effective policy development or reform.…”