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. 2018 Jun;8(1):010603.
doi: 10.7189/jogh.08.010603.

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

Mufaro Kanyangarara  1 , Victoria B Chou  1 , Andreea A Creanga  1   2 , Neff Walker  1
Affiliations

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

Mufaro Kanyangarara et al. J Glob Health. 2018 Jun.

Abstract

Background: Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries.

Methods: We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services.

Results: Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric services" (≥30% of facility deliveries) were only found in three countries.

Conclusions: The low levels of availability, readiness and coverage of obstetric services documented represent substantial missed opportunities within health systems. Global and national efforts need to prioritize upgrading EmOC functionality and improving readiness to deliver obstetric service, particularly in rural areas. The approach of linking health facility and household surveys described here could facilitate the tracking of progress towards quality obstetric care.

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Conflict of interest statement

Competing interests: The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no competing interests.

Figures

Figure 1
Figure 1
Obstetric service availability in health facilities in 17 low- and middle-income countries, 2007-2015. A. Percentage of health facilities by emergency obstetric care capability. B. Percentage of health facilities by availability of obstetric signal functions.
Figure 2
Figure 2
Obstetric service readiness in health facilities in 17 low and middle-income countries, 2007-2015.
Figure 3
Figure 3
Urban-rural inequalities in obstetric service availability and readiness in 17 low and middle-income countries, 2007-2015. A. Performance of obstetric signal functions by urban-rural location. B. Availability of general requirements, staff and guidelines, equipment and medicines and commodities by urban-rural location.
Figure 4
Figure 4
Coverage of obstetric services among women delivering in health facilities in 17 low- and middle-income countries, 2007-2015. A. Percentage of facility deliveries by emergency obstetric care capability. B. Percentage of facility deliveries by obstetric service readiness.
Figure 5
Figure 5
Obstetric service readiness by coverage of facility deliveries in 17 low and middle-income countries, 2007-2015.
See this image and copyright information in PMC

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