Poor availability of skilled birth attendants in Nigeria: a case study of enugu state primary health care system.
BACKGROUND
The Government of Enugu State plans to offer free perinatal services at the primary health care (PHC) centers in order to improve perinatal outcomes in the state, but it was not clear whether there are skilled birth attendants (SBAs) at the PHC level to implement the program.


OBJECTIVE
To determine whether there are sufficient numbers of SBAs in the public PHC system in Enugu State of Nigeria.


METHODS
This cross-sectional survey involved enumeration of health workers who worked at each public PHC facility in Enugu State and included verification of the qualifications and trainings of each health worker. Data analysis was performed with the help of Stata statistical package version 13 and results were presented in tables and as simple proportions.


RESULTS
There were 55 nurses and no midwife or doctor in the 152 PHC clinics studied. This number represents 0.36 nurses per health facility or about 9% (i.e., 55/608) of a minimum of 608 SBAs required for 24-h perinatal services at the 152 PHC clinics. There were 1233 junior community health extension worker/community health extension workers (JCHEW/CHEWs), averaging 8.1 JCHEW/CHEWs per PHC clinic.


CONCLUSIONS
Enugu State has an acute shortage of SBAs. We recommend employment of qualified SBAs and in-service training of the JCHEW/CHEW and nurses to upgrade their midwifery skills. Incorporation of competency-based midwifery training into the pre-service training curricula of nurses and JCHEW/CHEW would provide a more sustainable supply of SBAs in Enugu state.
Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria.
Peter O
PO
Nkwo
Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria.
Lucky O
LO
Lawani
Department of Pediatrics, University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria.
Agozie C
AC
Ubesie
Department of Management, University of Nigeria, Enugu Campus, Enugu, Nigeria.
Vincent A
VA
Onodugo
Department of Pediatrics, University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria.
Herbert A
HA
Obu
Department of Pediatrics, University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria.
Josephat M
JM
Chinawa
Maternal neonatal and child health care; Nigeria; Primary health care; Skilled birth attendant