An Assessment of the Availability of Essential Obstetric Care Services in the Birim South District.

Abstract

The availability and access to health services is very important in the management of obstetric complications and reduction of maternal mortality. A descriptive study was conducted in the Birim South District to describe the basic and comprehensive essential obstetric care services, and identify factors that affected availability. All facilities in the district both private and public that provided obstetric services were studied. A supervision checklist for hospitals and clinics was used to assess availability. The following signal functions: ability to administer parenteral antibiotics, parenteral oxytocic drugs, parenteral anticonvulsants for pre-eclampsia and eclampsia, perform manual removal of placenta, retained products of conception and assisted vaginal delivery were used to identify a facility as providing basic essential obstetric care services. A comprehensive essential obstetric care facility was identified as one able to perform all the signal functions for a basic essential obstetric care facility and in addition be able to perform caesarian section surgery and blood transfusion. An interview guide was designed and used to conduct key informant interviews with heads of the various facilities where obstetric services were provided. The key in formant interviews were conducted to determine factors associated with availability of services. Out of the 30 health facilities in the district, only 12 provided obstetric services. One provided comprehensive essential obstetric care services while the rest, provided basic essential obstetric care services. None of the 11 facilities providing basic essential obstetric care services however, could perform all the signal functions needed to be identified as a facility providing basic essential obstetric care services. The function performed by all these facilities was parenteral administration of oxytocic drugs. None of them performed assisted vaginal deliveries. The factors found to be associated with availability of essential obstetric care services were lack of trained personnel due to inappropriate distribution of staff and inadequate number of trained personnel, and malfunctioning or unavailability of the required equipment at the facility. Geographical accessibility and financial affordability also contributed to making EsOc services available. To improve availability of essential obstetric services in the district these recommendations are being proposed to the District Director of Health Services. There is the need to upgrade services to meet the required signal functions. There should be continuing in-service training for all staff to upgrade their skills. Some midwives need to be deployed to areas where their services are most needed. Malfunctioning equipment should immediately be repaired or replaced and those unavailable should be provided.