Although key health personnel were available, Emergency Obstetric Care (EmOC) services at the health facilities assessed in rural Nepal were below the minimum coverage level recommended by the World Health Organisation, a recently published study on Maternal and Child Health Journal found.
Public Health Perspective Nepal in collaboration with researchers from Nepal and the UK conducted a cross-sectional health facility survey in 2018 in all 16 public health facilities providing delivery services in the Taplejung District; one of the remote mountainous districts in eastern Nepal. For the survey, data enumerators visited 16 birthing centres and collected data using the core service availability and readiness assessment (SARA) questionnaire; the validated tool that has been designed to assess and monitor the service availability and readiness of health facilities. The data collectors also observed the essential items that allowed researchers to determine the availability and the condition of equipment, medicines and commodities for EmOC. The data was also extracted from the national Health Management Information System (HMIS) register of the included health facilities to determine the utilisation of EmOC signal functions and other maternal and newborn care services.
According to the study, only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities. As per the study, the overall readiness score was 76.8% for providing Basic EmOC, and the highest was for equipment (87.1%) and the lowest for staff and guidelines (51.3%). A higher-level health facility (District Hospital) had a higher readiness score than a lower-level health facility (HP), 95.8% versus 74.0%. The overall readiness score to provide Comprehensive EmOC was 70.0% and highest for staff and guidelines (100.0%) and diagnostics (100.0%), and the lowest for medicines and commodities (44.4%).
The study recommends that the Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy.
Authors: Amrit Banstola, Padam Simkhada, Edwin van Teijlingen, Surya Bhatta, Susma Lama, Abisha Adhikari, and Ashik Banstola.