EMERGENCY OBSTETRIC CARE AVAILABILITY, ACCESSIBILITY AND UTILIZATION IN EIGHT DISTRICTS IN PAKISTAN’S NORTH WEST FRONTIER PROVINCE

Authors

  • Moazzam Ali
  • Mohammad Ayaz
  • Humayun Rizwan
  • Saima Hashim
  • Chushi Kuroiwa

Abstract

Introduction: Reducing maternal mortality is a critical issue in Pakistan. Do public health carecenters in Pakistan’s North West Frontier Province (NWFP) comply with minimum UNrecommendations for availability, use, and quality of basic and comprehensive EmergencyObstetric Care (EmOC) as measured by UN process indicators? Methods : All public healthfacilities providing EmOC (n=50) in 30% of districts in NWFP province (n=8 districts) sampledrandomly in September 2003 were included in a cross-sectional study. Data came from healthfacility records. Results: Almost all indicators were below minimum recommended UN levels. Thenumber of facilities providing basic EmOC services was much too low to be called providingcomprehensive coverage. A low percentage of births took place in hospital and few women withcomplications reached EmOC facilities. Caesarean section was either underutilized or unavailable.The case fatality rate was low, perhaps due to poor record-keeping. Conclusion:The findings of this first needs assessment in NWFP province can serve as a benchmark formonitoring future progress. In resource-poor countries like Pakistan, it is important to upgradeexisting facilities, giving special emphasis to facilities that provide basic EmOC services, sincemany problems can be resolved at the most basic level. Health policy makers and planners need totake immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas,enhance staff skills through training, upgrade management and supervision, ensure medical supplyavailability, mandate proper record-keeping, and observe progress by monitoring process indicatorsregularly.Key Words: EmOC services, Process indicators, Mental Mortality, Public Hospital, Pakistan.

References

WHO. World Health Day Information Kit: Safe

Motherhood.1998. WHO: Geneva.

World Health Organization. The World Health Report 2005.

Make every women and child count. Geneva: WHO; 2005. pp

-62.

Desai J. The cost of emergency obstetric care: concepts and

issues. International Journal of Gynecology and Obstetrics

;81:74-82.

Thaddeus S, Maine D. Too far to walk: maternal mortality in

context. Soc Sci Med 1994; 38(8):1091-1110.

Maine D, Rosenfield A. The safe motherhood initiative: why

has it stalled? American Journal of Public Health

;89:480-482.

World Health Organization. Mother-baby package: a roadmap

for implementation in countries. Geneva. WHO, Division of

Family Health, 1994.

Fathalla MF. Human rights aspects of safe motherhood. Best

Practice and research.2006; 20(3):409-419.

Maine D, Wardlaw TM, Ward VM, McCarthy J, Birnbaum A,

Akalin MZ et al. Guidelines for monitoring the availability

and use of obstetric services. New York:

UNICEF/WHO/UNFPA, 1997.

McGinn T. Monitoring and evaluation of PMM efforts: what

we have learned? International Journal of Gynecology and

Obstetrics 1997; 59(suppl.2): S245-S251.

NIPS. Populat ion growth and its implications. National

Institute of Population Studies. Islamabad, Pakistan. 2005.

Maternal and infant mortality policy and interventions.

Pakistan, Karachi: Report of an International workshop at the

Agha Khan University; 1994.

Government of Pakistan. Pakistan Labor Force Survey 2003-4.

Statistics Division. Federal Bureau of Statistics. 2004.

Pakistan Statistical Year Book. Statistics Division. Federal

Bureau of Statistics. 2005.

NIPS. Pakistan population data sheet 2001. National Instit ute

of Population Studies. Islamabad, Pakistan. 2002.

Bailey P, Paxton A: Program Note. Using UN process

indicators to assess needs in emergency obstetric services

(Mozambique, Nepal and Senegal). International Journal of

Gynecology and Obstetrics 2002;76:299-305.

AMDD Working group on indicators: Program note. Using

process indicators to assess needs in emergency obstetric

services: Bhutan, Cameroon and Rajasthan, India.

International Journal of Gynecology and Obstetrics

;77:277-284.

Paxton A, Bailey P, Lobis S, Fry D.. Global patterns in

availability of emergency obstetric care. International Journal

of Gynecology and Obstetrics 2006:93,300-307.