An assessment of the capacity, status and burden of health facilities in Pakwach and Nebbi Districts to manage obstetric emergencies

Abstract

Background The capacity of the health facilities to handle emergency obstetric conditions in Uganda is low. Available data indicates a high number of facility registered and reported maternal deaths in Nebbi and Pakwach districts that the health services in these districts failed to avert. The study objective was to assess the capacity and status of health facilities in these 2 districts to manage obstetric emergencies using the World Health Organization Emergency obstetric care model. Methods A health facility survey was conducted in all designated emergency obstetric care facilities providing maternal and newborn care in Nebbi and Pakwach districts.Needs assessment tools based on the UN process indicatorswereused to quantify signal functions, infrastructure, equipment, supplies and human resources. Data on deliveries, complications and signal functions were collected from registers for six months from December 2017 to May 2018 and service providers were interviewed. Data was analysed using IBM SPSS software. Results None of the 16 designated basic EmOC facilities(0%) was able toprovide all 6 signal functions and only 2 of the 4(50%) designated comprehensive EmOC facilities able to provide all 8 functions. The performance of assisted vaginal delivery (10%) and administration of parenteral anticonvulsants (25%) were the least performed signal functions. Both districts had few doctors and midwives available for managing EmOC, with 2 doctors per 100,000 population and 2 midwives for 10,000 population.The staff interviewedin both districts have fair knowledgeof EmOC (62.83% for Nebbi and 62.50% for Pakwach (62.50%); p = 0.955).

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Conclusion The theoretical coverage of EmOC facilities in the Pakwach and Nebbi appears to be adequate but the actual functioning and provision of EmOC signal functions is very poor even by national standards. There is urgentneed to equip these facilities with all EmOC equipment and drugs as wellas improve staff capacity in terms of numbers and skills to perform all the signal functions for treatment of obstetric complications per facility level.