1. Bottleneck Analysis BEmOC and CEmOC
Group -2
Nepal, Bangladesh, Pakistan, Afghanistan , Sri Lanka, Indonesia

2. BEmONC Priority Bottlenecks Possible Solutions Supply side
Policy and Strategic Plan and Poor Governance
Inappropriate allocation of Fund
Insufficient HR/ Skilled Person/Distribution /Retention/Accredit
Policy Document need to be updated and scaled up
Proper allocation of fund and planning for MNCH services
Ensure 24/7 , task shifting
Production of SBA ( Mid wives) /strengthening
Performance based Incentive /enabling environment to address those issues

3. BEmONC Bottle Neck Possible Solution
Monitoring and Supervision
MIS
No structural or Poor Referral Mechanism
Strengthening of E-monitoring and supervision
Strengthening of MIS with analysis and action
Strengthening Accountability of all service providers
Referral Guidelines must be implemented and provision of Vehicle /PPP (Referral HUB)
Coordination between service delivery levels (mobile phone, Maternity waiting home etc)

4. BEmONC Bottle Neck Possible Solution
Demand side:
Lack of knowledge and decision power to use the BEmONC facilities.
Lack of Accessibility , acceptability and affordability of BEmONC facilities
In Equity
Geographical
(Urban rural, poor-rich)
Economic
Cultural
Women empowerment through education /BCC through communication (C4D)
Equitable availability of quality B & CmONC of care in the facility/PPP
Equity focused , evidence based LLP
Equitable resources allocation

5. Additional Bottleneck
CEmONC
Additional Bottleneck
Possible Solutions
Supply Side
Infrastructure
Diagnostic
OT (Operation Theater) HR
Maintenance
Blood Transfusion
Need based planning
Ensure trained manpower in place
Readiness of the facility according to the checklist
Ensure diagnostic and blood transfusion facility
Demand side Financing and PPP

6. Unique Problem Bottleneck Possible Solutions Pakistan Nepal
Natural Disaster
Geographical and sociocultural and Female Education
Nepal
Cultural
Geographical
Afghanistan
Financial Allocation
Security
Indonesia
Decentralization
No policy to support sustainability of BEmOC and CEmOC
Readiness for Emergency preparedness and response plan for Mother and Child
Culture appropriate need based plan
Establish policy for the functioning all public and private hospital to provide EmOC