title: Availability and use of emergency obstetric services: Kenya, Rwanda, Southern Sudan, and Uganda.
abstract: The article summarises the baseline assessments of emergency obstetric care (EmOC) carried out in Uganda, Kenya, Southern Sudan, and Rwanda in 2003 and 2004.
  
  
  OBJECTIVE
  Our objectives were to: (1) set up program baselines on the availability and utilization of EmOC services in these countries; (2) identify gaps and obstacles in providing EmOC services; and (3) make recommendations to governments based on evidence generated.
  
  
  METHODS
  Data were collected from clinical record reviews, provider and client interviews, observations, and focus group discussions. Either random or universal sampling was applied in the selection of health facilities assessed. Local nurses and midwives participated in the data collection and, to some extent, data processing and analysis.
  
  
  RESULTS
  The coverage of basic EmOC services ranged 0-1.1/500,000 population compared to the UN-recommended level of 4/500,000. The coverage of comprehensive EmOC services ranged 0.5-4.3/500,000 compared to the recommended level of 1/500,000. Between 0.6% and 8.8% of all births took place in EmOC facilities, and 2.1% and 18.5% of all expected direct obstetric complications were treated. Cesarean section as a proportion of all births was between 0.1% and 1%. Shortage of trained staff especially mid-level providers, poor basic infrastructure such as lack of electricity and water supplies, inadequate supply of drugs and essential equipment, poor working conditions and staff morale, lack of communication and referral facilities, cost of treatment, and lack of accountability and proper management were identified as the main obstacles in providing 24-h quality EmOC services especially in remote and rural areas.
  
  
  CONCLUSIONS
  Lack of basic EmOC services limits women's access to life-saving services during obstetric complications. To reduce maternal mortality ratio the states and development partners need to focus their effort to improve the coverage, quality, and utilization of EmOC services through supportive national policy, effective program strategies, increased budget allocation to maternal health program, rural infrastructure development, and regular monitoring, and evaluation of progress.
authors.affiliation: UNICEF Regional Office of Eastern and Southern Africa (ESARO), EmOC Working Group on Indicators, Gigiri, Nairobi, Kenya. lwpearson@unicef.org
authors.forename: L
authors.initials: L
authors.lastname: Pearson
authors.forename: R
authors.initials: R
authors.lastname: Shoo
mesh_terms: D001294:Attitude to Health; D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data / Q000600:supply & distribution; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007630:Kenya; D008427:Maternal Health Services / Q000592:standards* / Q000706:statistics & numerical data / Q000600:supply & distribution; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D012432:Rwanda; D013397:Sudan; D014454:Uganda