EMERGENCY OBSTETRIC CARE AVAILABILITY, ACCESSIBILITY AND UTILIZATION IN EIGHT DISTRICTS IN PAKISTAN’S NORTH WEST FRONTIER PROVINCE
AbstractIntroduction: Reducing maternal mortality is a critical issue in Pakistan. Do public health carecenters in Pakistan’s North West Frontier Province (NWFP) comply with minimum UNrecommendations for availability, use, and quality of basic and comprehensive EmergencyObstetric Care (EmOC) as measured by UN process indicators? Methods : All public healthfacilities providing EmOC (n=50) in 30% of districts in NWFP province (n=8 districts) sampledrandomly in September 2003 were included in a cross-sectional study. Data came from healthfacility records. Results: Almost all indicators were below minimum recommended UN levels. Thenumber of facilities providing basic EmOC services was much too low to be called providingcomprehensive coverage. A low percentage of births took place in hospital and few women withcomplications 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 formonitoring future progress. In resource-poor countries like Pakistan, it is important to upgradeexisting facilities, giving special emphasis to facilities that provide basic EmOC services, sincemany problems can be resolved at the most basic level. Health policy makers and planners need totake immediate, appropriate rectifying measures to, inter alia, improve staffing in rural areas,enhance staff skills through training, upgrade management and supervision, ensure medical supplyavailability, mandate proper record-keeping, and observe progress by monitoring process indicatorsregularly.Key Words: EmOC services, Process indicators, Mental Mortality, Public Hospital, Pakistan.
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