Study reveals inadequate access to EmONC facilities in 24 districts of Bangladesh

Nasmeen Ahmed

In an effort to further improve maternal and child health, the Government of Bangladesh (GoB) partnered with icddr,b to develop a Geographic Information System (GIS) to monitor and evaluate the country’s emergency obstetric and newborn care (EmONC) services ( icddr,b’s Centre for Equity & Health Systems released results from its GIS-based needs assessment at its main campus on 17 February. The study was conduct at medical college hospitals, district and upazila hospitals and some private health facilities in 24 districts between May and October 2012.

Study Findings

EmONC services have been part of the Bangladesh national reproductive health agenda for the last 30 years, but the system has lacked a tool to effectively monitor and evaluate its quality and availability.  icddr,b’s web-based GIS application allowed programme managers and policymakers to map the GPS locations of publicly designated EmONC facilities and evaluate how their distribution and geographical accessibility relate to population, road and waterway networks and more. Unless mothers can reach life-saving care in the event of an emergency, government services are of little use.

Study findings estimated that there are 1.2 comprehensive and 2.5 basic government-run EmONC facilities for every 500,000 people in the selected 24 study districts. Although private facilities in Bangladesh are not designated as EmONC facilities, a substantial number do offer obstetric and newborn care services in urban areas. In both public and private sectors combined, most of the study districts have more than the five facilities per 500,000 residents that UN guidelines require.

Of these five, at least one should function as a comprehensive facility by providing caesarean sections and blood transfusions. This is in addition to the basic services provided by the remaining facilities—administration of parental antibiotics, oxytocin and anticonvulsants; manual removal of the placenta; removal of retained products; assisted vaginal delivery and neonatal resuscitation.

Even though Bangladesh meets the minimum acceptable number of facilities, poor infrastructure and lack of trained personnel mean a reduced availability of services. Various GIS modeling exercises undertaken by the needs assessment study revealed that, in 24 districts, about 72% of the population has accessibility to a public designated comprehensive EmONC facility within two hours’ travel time. However, accessibility within the optimum one hour of travel time to a basic EmONC facility is 41%. In hill districts and hard-to-reach areas, the accessibility is much lower.

The study found 90% of obstetrician, gynaecologist and paediatric posts were occupied, but only 65% of anaesthesiologist posts were filled. Around 80% of senior staff nurse and staff nurse posts, and 50% of assistant nurse posts, were found vacant. At the upazila level, a substantial proportion of medical doctor posts were vacant. More than 60% of obstetrician/gynaecologist posts, and more than 70% anaesthesiologist and paediatric consultant posts were vacant.

The Way Forward

“This technology allows us to see the big picture and all pieces of the puzzle—to assess individual facilities to ensure that equipment, supplies, human resources and quality care are being providing during pregnancy, birth and the postnatal period,” said Dr. Mahbub Elahi Chowdhury, scientist with the icddr,b Centre for Equity & Health Systems. He will provide the Directorate General of Health Services (DGHS) with technical support for expansion of the study into all 64 districts of Bangladesh.

The needs assessment study of the 24 select districts recommended undertaking a strategic plan for increased coverage of EmONC services, developing a human resource plan for EmONC service delivery, strengthening infrastructural facilities and ensuring supply of drug equipment and logistics for EmONC services. At the 17 February programme, GoB Health Secretary MM Niazuddin termed the study unique and said the ministry will factor in the recommendations when conducting a midterm review of a different operation plan.

icddr,b developed the GIS application with technical assistance from the CEGIS (a local GIS application developing firm) under the partnership agreement with the UNFPA, Bangladesh. ArcGIS Server software was used as the development platform for the application and linked with the SQL server data sources based at icddr,b.

For further details, please contact Nasmeen Ahmed, senior manager, Communications, icddr,b.