Operational Barriers in Providing Quality Emergency Obstetric Care at First Referral Level Health Facilities in India
Availability, accessibility and quality of Emergency Obstetric Care (EmOC) services are most important interventions required to reduce maternal mortality due to complications that arise during pregnancy and childbirth. In India strategy to provide the EmOC at lowest level is through the network of First Referral Units (FRUs). Key determinants for FRUs being operational are availability of surgical Interventions, New-born Care and Blood Storage Facility on 24-hour basis. Many barriers have been documented in order to operationalize the FRUs. Government of India has introduced several training programmes for operationalization of FRUs.
Objectives:
- To access operationalization status of FRU for providing quality EmOC services.
- To identify the key determinants for quality EmOC services at FRU.
Methods:
Cross sectional study was done in 7 states of India including the 6 states with poor maternal health indicators. Quality monitoring was done at 50 FRUs. Semi-structured, pre-designed and pre- tested checklists were used for data collection. In depth interviews were also conducted with the key functionaries serving at the facility.
Results:
Median population catered by FRU was 300,000. Out total 50 FRUs visited operative infrastructure, obstetrician or person trained in EmOC, person trained in anaesthesia, and blood transfusion and referral linkage facilities were available at 60%, 75%, 62 %, 25% and 75% of the facilities respectively. Median number of support manpower i.e. basic medical doctors and nurses were 9 and 4 respectively. Emergency drugs and newborn care unit were available at 80% and 65%. Only 22% of the facilities had all four critical components of EmOC available and caesarian section deliveries were being performed at 18% of the facilities.
Conclusions:
Barriers in order to operationalize the network of FRUs in India are availability of all key elements together at a facility.