Proposing standardised geographical indicators of physical access to emergency obstetric and newborn care in low-income and middle-income countries

Abstract

Emergency obstetric and newborn care (EmONC) can be life-saving in managing well-known complications during childbirth. However, suboptimal availability, accessibility, quality and utilisation of EmONC services hampered meeting Millennium Development Goal target 5A. Evaluation and modelling tools of health system performance and future potential can help countries to optimise their strategies towards reaching Sustainable Development Goal (SDG) 3: ensure healthy lives and promote well-being for all at all ages. The standard set of indicators for monitoring EmONC has been found useful for assessing quality and utilisation but does not account for travel time required to physically access health services. The increased use of geographical information systems, availability of free geographical modelling tools such as AccessMod and the quality of geographical data provide opportunities to complement the existing EmONC indicators by adding geographically explicit measurements. This paper proposes three additional EmONC indicators to the standard set for monitoring EmONC; two consider physical accessibility and a third addresses referral time from basic to comprehensive EmONC services. We provide examples to illustrate how the AccessMod tool can be used to measure these indicators, analyse service utilisation and propose options for the scaling-up of EmONC services. The additional indicators and analysis methods can supplement traditional EmONC assessments by informing approaches to improve timely access to achieve Universal Health Coverage and reach SDG 3.

Keywords: emergency obstetric and newborn care; physical accessibility; sustainable development goals; universal health coverage.

Figure 1

(A) Example of a travel time distribution grid from one BEmONC facility (St Joseph Hospital): travel time between each BEmONC facility to the nearest CEmONC facility when considering (B) the current situation in terms of availability of a functioning motor vehicle and mode of communication, and (C) the hypothetical situation where all BEmONC facilities have a functioning motor vehicle on site, Cross River State, Nigeria. BEmONC, basic EmONC; CEmONC, comprehensive EmONC; EmONC, emergency obstetric and newborn care; LGA, local government area.

Figure 2

Region-level percentage of births covered by emergency obstetric and newborn care facilities as determined by the accessibility (ACC1) and the geographical coverage analysis (GEC) plotted against the percentage of births delivered in a public or private health facility in the preceding 5 years, Burkina Faso (modified from ref 23). DHS, Demographic and Health Survey.