Need Assessment of Emergency Obstetric and Neonatal Care (EmONC) in Selected Health Care Facilities across Pakistan Dr Farah Rashid Siddiqui Associate Professor Yusra Medical & Dental College Islamabad

Background The EmONC is a descriptive need assessment of selected health facilities of Pakistan. The assessment by definition examined only facility-based services. The current needs assessment is designed to identify needs and gaps and to inform programmatic efforts for increasing quality, coverage, and utilization of EmONC services

Basic EmONC (B.EmONC ) To qualify for a B. EmONC facility, the health centres and hospitals must have performed the following seven signal functions within the past 3 months (WHO, 2009) 1)administered parenteral antibiotics; 2)administered parenteral anticonvulsants; 3)administered parenteral oxtyocics; 4)performed manual removal of placenta; 5)performed removal of retained products (MVA) 6)performed assisted vaginal delivery (with vacuum extractor or forceps); and 7)performed neonatal resuscitation with bag and mask.

Comprehensive EmONC (C.EmONC For a C.EmONC facility, the hospitals must have performed following two additional signal functions besides above seven, within the past 3 months: Blood transfusion; and Caesarean section.

Objective: To assess the EmONC available in selected Health Care Facilities across Pakistan with a view to identify gaps and suggest measures to bridge those gaps in service delivery. This needs assessment examined facility readiness, provider skills, the quality of services, coverage and utilization of EmONC services.

Selection of Health Facilities 31 Basic EmONC health facilities in 14 districts and 11 Comprehensive EmONC health facilities in 10 districts of; Punjab, Sindh, KPK, Balochistan and AJK

Table 1: Distribution of type of health facility by Province for B.EmONC

Table 2: Distribution of type of health facility by Province for C.EmONC

Methodology & EmONC Assessment Tool: It was a cross-sectional survey conducted during Data was collected on a structured checklist. Key Informant interviews with; – EDOH, – Medical Officer In charge, – dispensers and – community members; were conducted

Indicators

B EmONC(%)C EmONC(%) Infrastructure status Staff availability Basic Equipment (Functional) EmONC equipment (Functional) Knowledge of LHVs on MNCH EmONC signal functions HIS stationary Client satisfaction7080 Disaster Management Plan Blood transfusion availableN/A91 C-Section performedN/A91 Lab services available Results

Comparison of the responses to the most important indicators information is presented in a consolidated manner (%) for EDOH, MO and Community members Indicators EDOH(%) MO(%) Community(%) 24/7 EmONC functionality EmONC services availability Staff well trained Disaster responsiveness695046

B.EmONC health facilities- comparison of data for March March 2010 March 2011 ANC 56,904 57,172 TT 32,90633,237 Deliveries 13,34414,009 PNC 12,48714,593 Children vaccinated for Measles 35,61133,256

C.EmONC health facilities- comparison of data for March March 2010March 2011 ANC23,179 26,462 Deliveries 21,09127,190 C-section PNC18,34419,417 Children vaccinated for Measles54,17365,329 Maternal deaths89 Neonatal deaths3036

1. Infrastructure Figure 1.1 B.EmONC Figure 1.2 C.EmONC

2. Staff Availability Figure 2.2 C.EmONC Figure 2.1 B.EmONC

3. Basic Equipment Availability & Functionality

4. EmONC related Equipment Availability & Functionality Figure 4.1 B.EmONC Figure 4.2 C.EmONC

5. HMIS- Figure 5.1 B.EmONCFigure 5.2 C.EmONC

. 6. Availability of Essential drugs Figure 6.1 B.EmONCFigure 6.2 C.EmONC

7. Knowledge of LHV on MNCH Figure 7.1 B.EmONCFigure 7.2 C.EmONC

8. Knowledge of WMOs on C-section sterilization and post-op care

9. Availability of EmONC services including all the signal functions Figure 9.1 B.EmONC Figure 9.2 C.EmONC

10.Disaster management plan for MNCH

The health facilities who shared the disaster management plan, had the following components covered; Extra beds are placed in the hospital for affectes Extra supplies are made available Coordination is made with donors Coordination is made with DGHS

11. Community Satisfaction Figure 11.1 B.EmONCFigure 11.2 C.EmONC

Conclusion There is a need to provide improved EmONC services through Quality, Effectiveness, Acceptability, Accessibility and Affordability. District wise Disaster Management Plans should be prepared with the active involvement of EDHOs, DHOs and other important stakeholders. Vertical programs like National MNCH program should be actively involved in Provincial and district disaster management plans for filling the gaps, training of staff and provision of Basic and Comprehensive EmONC services

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SECTION – V: AVAILABILITY OF LAB & DIAGNOSTIC SERVICES (Check, Observe And Report By Ticking Either “Yes” Or “No”) Sr.ServicesYesNo 1.Hemoglobin 2.Blood Grouping 3.TB Lab smear diagnostic services 4.Routine blood examination services 5.X-Rays chest services (Radiological services)

SECTION – VII: DRUG STOCK OUTS (YES MEANS DRUG OUT OF STOCK) (Check, Observe And Report By Ticking Either “Yes” Or “No”) Drug Items At the day of Visit During Last 3 Months If yes, number of stock out days in last 3 months YesNoYesNo 1.Antipyretic Syrups 2.Antibiotic Syrups 3.ORS 4.Zinc 5.Ferrous Sulphate 6.Deworming Syrups 7.Deworming Tablets 8.EmONC Drugs 9. RHZE (Rifampicin 150mg + Isoniazid 75mg + Pyrazinamde 400mg + Ethambutol 275mg) 10.HR (Isoniazid 100mg + Rifampicin 150mg) 11.Streptomycin (750mg)

SECTION – X Ask And Check The Figures For The Last 3 Months From Registers Quality Outcome/ Outcome Indicators# Number of women provided ANC Number of MNCH health education sessions held in the community Number of hygiene and sanitation health education sessions held in the community Number of exclusive breast feeding and family planning health education sessions held in the community Number of nutrition and home care of common illness health education sessions held in the community Number of training sessions of health care providers carried out * Number of women delivered in the health facility (Normal delivery) Number of C-section deliveries in health facility Number of women died during delivery Number of women referred for delivery and complications Number of children presented with diarrhea Number of children with diarrhea who died Number of children with presented with ARI Number of children with ARI who died Number of newborn referred Number of newborn who died Number of men (>18 years) diagnosed and treated through telemedicine Number of women (>18 years) diagnosed and treated through telemedicine Number of adolescents aged 5-18 years diagnosed and treated through telemedicine Number of children under 5 years age diagnosed and treated through telemedicine