Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda

  • International Journal of Gynecology and Obstetrics, Volume 88, No. 2, Year 2005

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Study Justification:
– The study aimed to assess the availability and utilization of emergency obstetric care (EmOC) services in Kenya, Rwanda, Southern Sudan, and Uganda.
– The objective was to identify gaps and obstacles in providing EmOC services and make recommendations to governments based on the evidence generated.
Highlights:
– The coverage of basic EmOC services ranged from 0 to 1.1 per 500,000 population, compared to the UN-recommended level of 4 per 500,000.
– The coverage of comprehensive EmOC services ranged from 0.5 to 4.3 per 500,000, compared to the recommended level of 1 per 500,000.
– Between 0.6% and 8.8% of all births took place in EmOC facilities, and 2.1% and 18.5% of all expected direct obstetric complications were treated.
– Cesarean section as a proportion of all births was between 0.1% and 1%.
– The main obstacles in providing 24-hour quality EmOC services were identified as shortage of trained staff, poor infrastructure, inadequate supply of drugs and equipment, poor working conditions and staff morale, lack of communication and referral facilities, cost of treatment, and lack of accountability and proper management.
Recommendations:
– To reduce maternal mortality ratio, it is recommended to improve the coverage, quality, and utilization of EmOC services.
– Supportive national policies, effective program strategies, increased budget allocation to maternal health programs, rural infrastructure development, and regular monitoring and evaluation of progress are needed.
Key Role Players:
– Government health departments
– Development partners
– Health facility administrators
– Trained healthcare providers
– Nurses and midwives
– Program managers
– Monitoring and evaluation teams
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Infrastructure development (electricity, water supplies)
– Supply of drugs and essential equipment
– Improvement of working conditions and staff morale
– Communication and referral facilities
– Cost of treatment subsidies or financial support
– Accountability and management systems
– Monitoring and evaluation activities

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study collected data from multiple sources and used a combination of qualitative and quantitative methods. However, the abstract does not provide specific details about the sample size or the representativeness of the selected health facilities. To improve the strength of the evidence, the authors could include more information about the methodology, such as the number of facilities assessed and the criteria used for selection. Additionally, providing more specific data on the coverage and utilization of EmOC services would enhance the evidence.

The article summarises the baseline assessments of emergency obstetric care (EmOC) carried out in Uganda, Kenya, Southern Sudan, and Rwanda in 2003 and 2004. Objectives: Our objectives were to: (1) set up program baselines on the availability and utilization of EmOC services in these countries; (2) identify gaps and obstacles in providing EmOC services; and (3) make recommendations to governments based on evidence generated. Methods: Data were collected from clinical record reviews, provider and client interviews, observations, and focus group discussions. Either random or universal sampling was applied in the selection of health facilities assessed. Local nurses and midwives participated in the data collection and, to some extent, data processing and analysis. Results: The coverage of basic EmOC services ranged 0-1.1/500,000 population compared to the UN-recommended level of 4/500,000. The coverage of comprehensive EmOC services ranged 0.5-4.3/500,000 compared to the recommended level of 1/500,000. Between 0.6% and 8.8% of all births took place in EmOC facilities, and 2.1% and 18.5% of all expected direct obstetric complications were treated. Cesarean section as a proportion of all births was between 0.1% and 1%. Shortage of trained staff especially mid-level providers, poor basic infrastructure such as lack of electricity and water supplies, inadequate supply of drugs and essential equipment, poor working conditions and staff morale, lack of communication and referral facilities, cost of treatment, and lack of accountability and proper management were identified as the main obstacles in providing 24-h quality EmOC services especially in remote and rural areas. Conclusions: Lack of basic EmOC services limits women’s access to life-saving services during obstetric complications. To reduce maternal mortality ratio the states and development partners need to focus their effort to improve the coverage, quality, and utilization of EmOC services through supportive national policy, effective program strategies, increased budget allocation to maternal health program, rural infrastructure development, and regular monitoring, and evaluation of progress. © 2004 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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Based on the article “Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda,” one innovation to improve access to maternal health is the implementation of mobile health clinics equipped with emergency obstetric care services in remote and rural areas. These clinics can travel to areas where access to healthcare facilities is limited, providing necessary care and reducing barriers faced by pregnant women in accessing timely and life-saving services during obstetric complications. This approach can also serve as a platform for health education and awareness campaigns, contributing to reducing maternal mortality and improving overall maternal health outcomes.
AI Innovations Description
Based on the article “Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda,” here is a recommendation that can be developed into an innovation to improve access to maternal health:

Recommendation: Implement mobile health clinics equipped with emergency obstetric care services in remote and rural areas.

Explanation: The article highlights several obstacles in providing 24-hour quality emergency obstetric care (EmOC) services, especially in remote and rural areas. These obstacles include a shortage of trained staff, poor infrastructure, inadequate supplies, and lack of communication and referral facilities. To address these challenges and improve access to maternal health, the recommendation is to introduce mobile health clinics.

Mobile health clinics can be equipped with the necessary equipment, drugs, and trained staff to provide emergency obstetric care services. These clinics can travel to remote and rural areas, reaching women who may otherwise have limited access to healthcare facilities. By bringing the services closer to the communities, it can reduce the barriers faced by pregnant women in accessing timely and life-saving care during obstetric complications.

The mobile health clinics can also serve as a platform for health education and awareness campaigns, providing information on prenatal care, safe delivery practices, and family planning. This holistic approach can contribute to reducing maternal mortality and improving overall maternal health outcomes.

Implementing mobile health clinics would require collaboration between governments, development partners, and healthcare organizations. Adequate funding, resource allocation, and regular monitoring and evaluation of the program’s progress would be essential to ensure its effectiveness and sustainability.

By leveraging innovative solutions like mobile health clinics, countries can work towards achieving the recommended coverage, quality, and utilization of EmOC services, ultimately reducing maternal mortality ratios and improving maternal health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations mentioned in the abstract on improving access to maternal health, the following methodology can be employed:

1. Define the target population: Identify the specific population group that will benefit from the implementation of mobile health clinics equipped with emergency obstetric care services. This could include pregnant women residing in remote and rural areas of the countries mentioned in the article (Kenya, Rwanda, Southern Sudan, and Uganda).

2. Collect baseline data: Gather data on the current availability and utilization of emergency obstetric care services in the target population. This can be done through surveys, interviews, and record reviews, similar to the methods used in the original article.

3. Develop a simulation model: Create a simulation model that incorporates the key variables and factors influencing access to maternal health services. This model should consider factors such as distance to healthcare facilities, availability of trained staff, infrastructure, supplies, and communication and referral systems.

4. Introduce the intervention: Simulate the implementation of mobile health clinics equipped with emergency obstetric care services in the target population. This can be done by adjusting the relevant variables in the simulation model to reflect the presence and functioning of these clinics.

5. Measure the impact: Use the simulation model to assess the impact of the intervention on improving access to maternal health services. Measure indicators such as the increase in the coverage of emergency obstetric care services, reduction in maternal mortality ratios, and improvement in maternal health outcomes.

6. Sensitivity analysis: Conduct sensitivity analysis to evaluate the robustness of the results. This involves testing the model with different assumptions and scenarios to assess the potential variations in the impact of the intervention.

7. Policy recommendations: Based on the simulation results, provide evidence-based policy recommendations to governments and development partners. These recommendations should focus on scaling up the implementation of mobile health clinics and addressing any identified barriers or challenges.

It is important to note that this methodology is a hypothetical approach to simulate the impact of the recommendations mentioned in the abstract. The actual implementation and evaluation of such an intervention would require extensive planning, resources, and collaboration between stakeholders.


Statistics:
Citations: 103
Identifiers:
DOI: 10.1016/j.ijgo.2004.09.027
ISSN: 00207292
Research Areas:
Environmental, Health System and Policy, Maternal and Child Health, Quality of Care, Workforce
Study Countries:
Kenya, Multi-Countries, Rwanda, Sudan, Uganda
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Qualitative
Participants Gender:
Female
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