EMERGENCY OBSTETRIC CARE AVAILABILITY, ACCESSIBILITY AND UTILIZATION IN EIGHT DISTRICTS IN PAKISTAN'S NORTH WEST FRONTIER PROVINCE
Abstract
Introduction: Reducing maternal mortality is a critical issue in Pakistan. Do public health carecenters in Pakistan's North West Frontier Province (NWFP) comply with minimum UN
recommendations for availability, use, and quality of basic and comprehensive Emergency
Obstetric Care (EmOC) as measured by UN process indicators? Methods : All public health
facilities providing EmOC (n=50) in 30% of districts in NWFP province (n=8 districts) sampled
randomly in September 2003 were included in a cross-sectional study. Data came from health
facility records. Results: Almost all indicators were below minimum recommended UN levels. The
number of facilities providing basic EmOC services was much too low to be called providing
comprehensive coverage. A low percentage of births took place in hospital and few women with
complications reached EmOC facilities. Caesarean section was either underutilized or unavailable.
The case fatality rate was low, perhaps due to poor record-keeping. Conclusion:
The findings of this first needs assessment in NWFP province can serve as a benchmark for
monitoring future progress. In resource-poor countries like Pakistan, it is important to upgrade
existing facilities, giving special emphasis to facilities that provide basic EmOC services, since
many problems can be resolved at the most basic level. Health policy makers and planners need to
take immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas,
enhance staff skills through training, upgrade management and supervision, ensure medical supply
availability, mandate proper record-keeping, and observe progress by monitoring process indicators
regularly.
Key Words: EmOC services, Process indicators, Mental Mortality, Public Hospital, Pakistan.
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