Health facility readiness to provide quality emergency obstetric and newborn care in rural Uganda: a cross- sectional study

Abstract

Introduction Despite efforts to improve maternal and newborn care services, maternal and newborn mortality in Uganda remains high. Over half of births occur in lower- level health facilities, where limited readiness and suboptimal quality of care may hinder the provision of emergency obstetric and newborn care (EmONC). This study aimed to assess health facility readiness to provide quality EmONC in Kasese and Bundibugyo districts, midwestern Uganda. Methods A cross- sectional survey was conducted in all 42 district- level public health facilities (health centre (HC) IIIs, HC IVs and general hospitals) offering childbirth services in Kasese and Bundibugyo districts. We used a facility assessment questionnaire based on the WHO’s Service Availability and Readiness Assessment and the Averting Maternal Death and Disability tool. Composite readiness scores were calculated across five domains (human resources, physical resources, referral, equipment and drugs and supplies) and signal functions by health facility level. HCIII facilities were considered Basic EmONC (BEmONC), while HC IVs and general hospitals were considered comprehensive EmONC (CEmONC) facilities. Results The overall mean availability of expected signal functions was 42.3%, and overall readiness was 53.3%. These were lowest in HCIIIs. The least provided CEmONC signal function was blood transfusion, available in 83.3% (n=5) of the CEmONC- designated facilities, and assisted vaginal delivery was the most frequently missing BEmONC signal function, with no facilities reporting its provision. Staffing and training were most available at 70.6%, while physical resources (44%) and functional referral system (44.7%) were least available. Conclusions EmONC signal function availability and overall readiness were suboptimal, particularly at HC IIIs. Strengthening the capacity and readiness of HC IIIs, improving essential resources and enhancing referral systems should be prioritised to improve access to quality EmONC.