Student Dissertation

Agency : Gap Analysis; Maternal and Newborn Health; Newborn Healthcare Service; Healthcare delivery Services

Objective : To assess the availability of required Infrastructure and basic facilities for effective functioning of the labour room, availability of Human Resource (HR) against the sanctioned strength of the institution and their training status, availability of essential medicines, functional 11 equipment’s and instruments in the labour room for qualitative service delivery and the adherence to infection prevention practices in the labour room.

Background : Pregnancy and motherhood are natural processes in the lives of women of reproductive age. It is observed that the highest proportion of maternal and newborn deaths takes place during and immediately after childbirth which can be preventable through appropriate care of mothers during and after labour and appropriate care of the newborns immediately after birth. This points out to the need for improving the quality of practices in the labour room. This study is an attempt to identify the gaps in service delivery at L2 and L3 delivery points of Alirajpur district so that suggestions can be made according to the operational guidelines of MCH and quality of care can be improved.

Methodology : Descriptive Cross-sectional study was done in Alirajpur District of Indian state Madhya Pradesh. Study duration was three months. The sample was collected from all the identified L3 and L2 delivery points of Alirajpur district. (Two level 3 and fifteen level 2). Primary data was collected through observation of the identified facilities and interview of all the respondents. Secondary data was collected from registers and facility records with the help of preformed standardized checklists.

Findings : L3 Delivery Points: It was observed that both the delivery points were functioning in government building with 24*7 water supply and functional power back up. Separate toilets were available for males and females with poor cleanliness and hygiene. Only 50 percent of the labour tables were covered with mackintosh sheet and cleanliness was poor. ï‚· There were only two gynecologists and one anesthetist available at the two facilities; none of the Medical Officers in both the delivery points were CEmOC trained. ï‚· Basic equipment’s like Thermometer and Pantograph charts were not available in 50% of the facilities. Equipment’s like Artery forceps, sponge holding forceps and episiotomy scissors were rusted in 50 percent of the facilities. ï‚· Essential Medicines like Tab. Misoprostol and Nevirapine syrup were not available in 50 percent of the delivery points. Biomedical waste segregation in colour coded bins and use of autoclave for sterilization of instruments was done in only 50 percent of the facilities. L2 Delivery Points: ï‚· It was observed that all the delivery points were functioning in government building. Only 40 percent of the facilities had functional power backup and clean separate toilets for men and women. New born care corners were available in 33 percent of the facilities. Separate labour room was available in all the facilities but elbow operated taps were available only in 33 percent of the facilities. 24*7 piped water supply was available in only 67 percent of the facilities. ï‚· It was observed that only 34 percent of the delivery points had available Medical officers and Paramedical staff according to delivery load. ï‚· It was observed that basic equipment’s like Thermometer, Pantograph, Disposable delivery kits and Oxygen Cylinders were available in 60 percent, 47 percent and 66 percent of the facilities. Only 46 percent of the facilities applied Biomedical waste segregation in colour coded bin. Autoclave for sterilization and soap for hand washing was available at 60 percent of the facilities. Slippers for service providers were available at 33 percent of the labour rooms. Only 13 percent of the labour rooms were sterilized on a regular basis.

Recommendations : It has been identified that there is a huge gap in availability of manpower and also in adherence to infection prevention practices at the labour rooms. Hence there is need to address the gaps.

To improve the quality of care it is necessary to analyse the gaps in functioning of the delivery points for strengthening their services, to provide comprehensive maternal health services.