Situation analysis of emergency obstetric care [EOC] in four districts of Sindh

ABSTRACT

The Society of Obstetricians and Gynaecologists of Pakistan [SOGP] in collaboration with the National Committee on Maternal Health [NCMH] and UNICEF [Sindh] carried out a situation analysis of facilities for emergency obstetric care [EOC] in Sindh. The purpose of this study was to survey and document the status of essential supplies, equipment, knowledge and skills of service providers for EOC and also community's health seeking preferences for maternity services. In District South of Karachi, Hyderabad, Nawabshah and Larkana Districts approximately 30 primary, secondary and tertiary care level hospitals of both government [20] and private sector [28] providing maternity services were surveyed. The assessment tool had three defined data gathering instruments for health facility survey, service provider's knowledge and skills and community survey. Analysis showed that 12% of the facilities did not function after 200 p.m. Twenty four hours coverage for complicated deliveries was provided in all tertiary care hospitals, while it was available in only 88% of the secondary care level hospitals. Transport for referral was present in 35% facilities and 65% of the facilities had blood transfusion services. Record of maternal mortality was available in 55% of the centers. Thirty three% of the government and 76% of the private hospitals were equipped with the basic minimum requirements to deal with obstetric emergencies. The health providers knowledge and skills regarding life threatening situations were variable ranging between 37-75% of the standards. Skills required of EOC were not learnt during training by 0-50%, while about 50% had not performed these skills in the last six months. Community survey showed that private hospitals [63%] were preferred over government hospitals [37%] for delivery. The reasons for these were varied