Readiness of health facilities to provide emergency obstetric care in Papua New Guinea: evidence from a cross-sectional survey

Abstract

ObjectiveTo measure the readiness of health facilities in Papua New Guinea (PNG) to provide obstetric care and other maternal health services.DesignCross-sectional study involving random sample of health centres, district/rural hospitals (levels 3 and 4 facilities) and all upper-level hospitals operational at the time of survey. Structured questionnaires were used to collect data from health facilities.SettingHealth facilities in PNG. Facility administrators and other facility personnel were interviewed. Number of facility personnel interviewed was usually one for health centres and two or more for hospitals.Participants19 upper-level facilities (levels 5–7, provincial, regional and national hospitals) and 60 lower-level facilities (levels 3 and 4, health centres and district/rural hospitals).Outcome measuresFour service-types were used to understand readiness of surveyed health facilities in the provision of maternity care including obstetric care services: (1) facility readiness to provide clinical services; (2) availability of family planning items; (3) availability of maternal and neonatal equipment and materials; and (4) ability to provide emergency obstetric care (EmOC).Results56% of lower-level facilities were not able to provide basic emergency obstetric care (BEmOC). Even among higher-level facilities, 16% were not able to perform one or more of the functions required to be considered a BEmOC provider. 11% of level 3 and 4 health facilities were able to provide comprehensive emergency obstetric care (CEmOC) as compared with 83% of higher-level facilities.ConclusionGiven the high fertility rate and maternal mortality ratio (MMR) in PNG, lack of BEmOC at the first level inpatient service providers is a major concern. To improve access to EmOC, level 3 and 4 facilities should be upgraded to at least BEmOC providers. Significant reduction in MMR will require improved access to CEmOC and optimal geographic location approach can identify facilities to be upgraded.