Assessment of facility and health worker readiness to provide quality antenatal, intrapartum and postpartum care in rural Southern Nepal

Background Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods Us...

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Published in:BMC health services research Vol. 20; no. 1; pp. 16 - 12
Main Authors: Lama, Tsering P., Munos, Melinda K., Katz, Joanne, Khatry, Subarna K., LeClerq, Steven C., Mullany, Luke C.
Format: Journal Article
Language:English
Published: London BioMed Central 06.01.2020
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Attended births
Birthing centers
Births
Business logistics
Childbirth & labor
Clinical Competence - statistics & numerical data
Developing countries
Eclampsia
Evaluation
Facility Readiness
Female
Health Administration
Health care
Health Facilities
Health Informatics
Health Personnel
Health services
Health Services Research
Health systems and services in low and middle income settings
Health worker knowledge
Hospitals
Human Development Index
Humans
Infant care
Infant, Newborn
Infrastructure
Interviews
LDCs
Magnesium compounds
Magnesium sulfate
Maternal & child health
Maternal care
Maternal Health Services
Maternal mortality
Medical care quality
Medical personnel
Medicine
Medicine & Public Health
Midwifery
Midwives
Nepal
Newborn babies
Newborn care
Newborn infants
Nurses
Nursing Research
Obstetrics
Patient care
Penicillin
Perinatal Care
Physicians
Population
Postnatal Care
Postpartum period
Preeclampsia
Pregnancy
Prenatal Care
Primary health care
Public Health
Quality of care
Quality of Health Care
Research Article
Rural health care
Rural Health Services
Sulfates
Workers
Nepal
Newborn care
Maternal care
Health worker knowledge
Facility Readiness
Quality of care
Nepal
ISSN:1472-6963, 1472-6963
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Summary:Background Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. Methods Using an audit tool and interviews, respectively, facility readiness and health providers’ knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. Results Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. Conclusions Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.
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ISSN:1472-6963
1472-6963
DOI:10.1186/s12913-019-4871-x