Utilization of Equipment for Emergency Obstetric Care in the Sub Districts Level Facilities in Bangladesh

Background: Comprehensive Emergency Obstetric Care (C-EmOC) equipment were provided to 47 Upazila Health Complexes (UHCs) and Basic Emergency Obstetric Care (B-EmOC) equipment to 192 UHCs in 2003-2004. The tools required for repairing the equipment were also provided to the National Electro-Medical Equipment Maintenance Workshop and Training Centre (NEMEW&TC) in Dhaka and District Electro-Medical Equipment Maintenance Workshops (DEMEW) in 18 districts. Japan International Cooperative Agency (JICA) provided financial support to purchase and distribute of these logistics. This study explored the utilization of EmOC equipment in the sub-district facilities.

Methodology: A mix-method, includes both qualitative and quantitative approach, was used to conduct the study during the period of January to June 2014. The study was conducted to understand the status of logistics after 10 years of distribution and utilization in the health facilities. Status of equipment was collected through a self-administrated questionnaire in all facilities (n=213). In-depth information was collected using a structured checklist in randomly selected 26 UHCs and 11 DEMEWs. Research Officers also visited additional 7 UHCs to validate the information received, of which 3 were the highest performing, 2 were lowest performing and 2 UHCs from where authority informed about not receiving any instruments from JICA.

Results: The study explored that 95% instruments were available and 52.9% were currently being used, 17.4% were not being used, 5.9% repairable and 6.4% damaged equipment. Most of the EmOC instruments were found at labour room and in operation theatre at the usable stage. Some instruments were found in the emergency room, storerooms, nursing room, pathology rooms, and doctors' room and in the computer room. In some of the UHCs, almost all the instruments remained intact in the storeroom or operation theatre. In UHC 36.3% of the respondents reported that some of the equipment was not functioning and 51.5% of the respondent knows regarding the Government regulatory policy for maintenance of EmOC equipment. Maternal and neonatal deaths were lower in health facilities with Comprehensive equipment than those of who had received Basic instruments. In DEMEWs 04 respondents among 11 reported that they had required a number of tools for maintenance EmOC instruments.

Conclusion: The study identified a gap between supplies and utilization of essential equipment for emergency obstetric care. It needs to explore further on how best optimum unitization of equipment can be ensured within the available resource.