title: Coverage of emergency obstetric care and availability of services in public and private health facilities in Bangladesh.
abstract: OBJECTIVE
  To assess the coverage of emergency obstetric care (EmOC) and the availability of obstetric services in Bangladesh.
  
  
  METHODS
  In a national health facility assessment performed between November 2007 and July 2008, all public EmOC facilities and private facilities providing obstetric services in the 64 districts of Bangladesh were mapped. The performance of EmOC services in these facilities during the preceding month was investigated using a semi-structured questionnaire completed through interviews of managers and service providers, and record review.
  
  
  RESULTS
  In total, 8.6 (2.1 public and 6.5 private) facilities per 500000 population offered obstetric care services. Population coverage by obstetric care facilities varied by region. Among 281 public facilities designated for comprehensive EmOC, cesarean delivery was available in only 215 (76.5%) and blood transfusion services in 198 (70.5%). In the private sector (for profit and not for profit), these services were available in more than 80% of facilities. In all facility types, performance of assisted vaginal delivery (range 12.2%-48.4%) and use of parenteral anticonvulsants to treat pre-eclampsia/eclampsia (range 48.6%-80.8%) were low. The main reason for non-availability of EmOC services was a lack of specialist/trained providers.
  
  
  CONCLUSIONS
  Bangladesh needs to increase the availability of EmOC services through innovative public-private partnerships. In the public sector, additional trained manpower supported by an incentivized package should be deployed.
authors.affiliation: Liverpool Hope University, Liverpool, UK.
authors.forename: Badrul
authors.initials: B
authors.lastname: Alam
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; University of California, Davis, Davis, CA, USA.
authors.forename: Malay K
authors.initials: MK
authors.lastname: Mridha
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Taposh K
authors.initials: TK
authors.lastname: Biswas
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Lumbini
authors.initials: L
authors.lastname: Roy
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Maksudur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh. Electronic address: melahi@icddrb.org.
authors.forename: Mahbub E
authors.initials: ME
authors.lastname: Chowdhury
mesh_terms: D001459:Bangladesh; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000458:organization & administration*; D011225:Pre-Eclampsia / Q000628:therapy; D011247:Pregnancy; D017149:Private Sector; D017150:Public Sector; D055818:Public-Private Sector Partnerships; D011795:Surveys and Questionnaires
keywords: Bangladesh; Blood transfusion; Cesarean delivery; Emergency obstetric care; Private facilities; Public facilities