Service Availability and readiness to provide emergency Obstetric care among health facilities that refer to Kawempe National Referral Hospital: A situational analysis

Abstract

Introduction: According to World Health Organization (WHO), 99% of global deaths that arise from pregnancy and its complications occur in the developing world, and 50% of these, occur in sub-Saharan Africa, due to weak health systems including poor referral systems, unskilled health workers and poor transport systems that don’t support emergency obstetric care (EmOC). In 2018, Kawempe national referral hospital (KRNH) served 31,654 mothers, of which 9,496 (30%) were referrals. These referrals constrain KNRH to provide quality health care due to patient overload. Thus a need to assess the service availability and readiness to provide EmOC among those health facilities that refer women with emergency obstetric complications to KNRH. Objective: The study assessed service availability and readiness to provide EmOC among health facilities in the greater Kampala metropolitan area that refer women to Kawempe National Referral Hospital. Methodology: The study used a cross-sectional study design with a quantitative data collection method. Overall, 675 referred women that were referred with emergency obstetric conditions met inclusion criteria and were recruited for the study during the 3 months period from October to December 2020. Baseline characteristics, type of obstetric conditions, names of referring health facilities, and reasons for referral were obtained from the referral note and through the use of a questionnaire. To determine the capacity of referring health facilities in provision of EmOC, 10 referring health facilities were interviewed using the WHO service availability and readiness assessment (SARA) tool. Analysis: Descriptive statistics were employed to analyze data from this study by using SPSS Ver. 25. Data were summarized and presented as numbers and percentages in line with objectives 1 and 2 of the study. Objective 3 findings were summarised as adequate or inadequate for the provision of emergency obstetric care based on 8 signal functions about the referring health facilities. Results: The study found out that, the mean age of referred women was 26 years, the majority (37%) of respondents were between the ages of 20-24 years, the major obstetric conditions of referred women to KNRH, included obstructed labor (11%), prolonged labor and severe preeclampsia (SPET) (10%), Prelabor premature rupture of membranes (PPROM at 8%), antepartum hemorrhage (APH) 4%, postpartum hemorrhage (PPH) 3% and retained placenta 1%. The study further found out that, the major top ten reasons for referral were – further management and SPET (10%), obstructed labor, previous scars and prolonged labor (8%), preterm labor, fetal distress and, premature rupture of membranes (6%), no doctor available (5%), and birth asphyxia (4%). This study revealed that 33% of the referred women had been referred to the health facility that referred them again to KNRH, 78% of the referred women didn't receive any form of treatment before being referred to KNRH, 76% of the referred women were referred by a mid-wife, 55% had access to transport and 72% reached KNRH within 3 hours of being referred. The study further revealed that 62% of all referred women to KNRH came from Kisenyi and Kawaala HC IVs. Lastly, the study revealed that all 10 referring health facilities had adequate (100%) service availability to offer EmOC but had inadequate (55% and 50% respectively) service readiness to offer CEmOC mainly due to lack of training in CEmOC and lack of access to a surgical team for 24 hours a day. Conclusion: The study recommends that Ministry of Health (MoH) to revitalize and institute communication channels between referring health facilities and recipient health facilities in order to avoid double referrals, MoH to institute a training plan on CEmOC and avail CEmOC service provision guidelines to all referring health facilities especially Kisenyi and Kawaala HC IVs so as to minimize unnecessary referrals by improving on their service readiness. Lastly, a study can be carried out to identify the mismatch between staffing levels and output at these health facilities that were assessed under this study.