The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia

Abstract

BackgroundBasic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC.MethodsBefore and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose–response relationships between outcome and explanatory variables of interest using regression methods.ResultsThe BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose–response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1–6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need.ConclusionThe BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1751-z) contains supplementary material, which is available to authorized users.

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

“…According to this study, obstetric care providers who have been working at health centers were 3.5 times more likely to use partograph compared to those who have been working at hospitals. The possible explanation might be the majority of the obstetric care providers working in health centers received on-the-job refresher training on partograph, BEONC training, and frequent supervision as compared to those working in hospitals [ 68 ]. The other reason might be health center obstetric care providers use partograph as a guide to take early action, to have adequate evidence, and to refer to higher health institution, which might increase its use.…”

Partograph utilization as a decision making tool and associated factors among obstetric care providers in Ethiopia: A systematic review and Meta-analysis

“…According to this study, obstetric care providers who have been worked at health centers were 3.5times more likely to use partograph compared to hospitals. The possible explanation might be the majority of the obstetric care providers working in health centers received on-the-job refresher training on partograph, BEONC training, and frequent supervision as compared to those working in hospitals [72]. The other reason might be health center obstetric care providers use partograph as a guide to take early action, to have adequate evidence, and to refer to higher health institution, which might increase its use.…”

Improving Post Abortion Care (PAC) Delivery in Sub-Saharan Africa: A Literature Review

“…Post abortion care (PAC) through manual vacuum aspiration (MVA) of retained products of conception is one of the seven signal functions of basic emergency obstetric and newborn care (BEmONC) and this constitutes one of the global strategies for the fight against unsafe abortion-related maternal mortality [12].…”