title: Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh.
abstract: BACKGROUND
  Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision.
  
  
  METHODS
  Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints.
  
  
  RESULTS
  The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in public facilities.
  
  
  CONCLUSIONS
  Although EmOC availability and readiness was higher among the surveyed seven most commonly visited private clinics, public facilities appeared to be more affordable for C-section and more geographically accessible. Strategies to retain anesthesiologists and surgeons, such as non-financial incentives, are needed to improve EmOC provision in the public sector. Centralized blood banks are recommended to streamline safe blood acquisition for obstetric surgeries.
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. ssikder@jhsph.edu.
authors: Shegufta S
authors: SS
authors: Sikder
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. alabriqu@jhsph.edu.
authors: Alain B
authors: AB
authors: Labrique
authors: The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh. hasmot.jivita@gmail.com.
authors: Hasmot
authors: H
authors: Ali
authors: The JiVitA Maternal and Child Health Research Project, Gaibandha, Bangladesh. hanif.rp.jivita@gmail.com.
authors: Abu A M
authors: AA
authors: Hanif
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. rklemm@jhsph.edu.
authors: Rolf D W
authors: RD
authors: Klemm
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. smehra@jhsph.edu.
authors: Sucheta
authors: S
authors: Mehra
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kwest@jhsph.edu.
authors: Keith P
authors: KP
authors: West
authors: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. pchrist1@jhu.edu.
authors: Parul
authors: P
authors: Christian
mesh_terms: D001459:Bangladesh; D002391:Catchment Area, Health; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D017149:Private Sector; D017150:Public Sector; D011785:Quality Assurance, Health Care; D012424:Rural Population / Q000706:statistics & numerical data
references: Bull World Health Organ. 2011 Aug 1;89(8):583-93
references: 21836757
references: Trials. 2011;12:102
references: 21510905
references: Int J Gynaecol Obstet. 2009 Oct;107 Suppl 1:S65-85, S86-8
references: 19815201
references: Lancet. 2004 Sep 4-10;364(9437):900-6
references: 15351199
references: Int J Gynaecol Obstet. 2006 Nov;95(2):192-208
references: 17074557
references: J Health Popul Nutr. 2009 Apr;27(2):124-38
references: 19489411
references: PLoS Med. 2011 Apr;8(4):e1000433
references: 21532746
references: Hum Resour Health. 2003 Nov 25;1(1):12
references: 14641940
references: BMC Health Serv Res. 2008;8:19
references: 18215313
references: J Health Popul Nutr. 2009 Apr;27(2):139-55
references: 19489412
references: BMC Pregnancy Childbirth. 2014;14:347
references: 25282340
references: Asian J Transfus Sci. 2009 Jul;3(2):108-10
references: 20808657
references: Int J Equity Health. 2007 Aug 30;6:9
references: 17760962
references: Int J Gynaecol Obstet. 2006 Jun;93(3):300-7
references: 16682039
references: PLoS One. 2013;8(1):e54066
references: 23349786
references: J Health Popul Nutr. 2012 Jun;30(2):124-30
references: 22838155