Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF ‘Every Mother Every Newborn (EMEN)’ standards

Background This manuscript presents findings from a

baseline assessment of health facilities in Bangladesh

prior to the implementation of the ‘Every Mother Every

Newborn Quality Improvement’ initiative.

Methodology A cross-sectional survey was conducted

between June and August 2016 in 15 government health

facilities. Structural readiness was assessed by observing

the physical environment, the availability of essential drugs

and equipment, and the functionality of the referral system.

Structured interviews were conducted with care providers

and facility managers on human resource availability and

training in the maternal and newborn care. Observation of

births, reviews of patient records and exit interviews with

women who were discharged from the selected health

facilities were used to assess the provision and experience

of care.

Results Only six (40%) facilities assessed had designated

maternity wards and 11 had newborn care corners. There

were stock-outs of emergency drugs including magnesium

sulfate and oxytocin in nearly all facilities. Two-thirds of

the positions for medical officers was vacant in district

hospitals and half of the positions for nurses was vacant

in subdistrict facilities. Only 60 (45%) healthcare providers

interviewed received training on newborn complication

management. No health facility used partograph for labour

monitoring. Blood pressure was not measured in half

(48%) and urine protein in 99% of pregnant women. Only

27% of babies were placed skin to skin with their mothers.

Most mothers (97%) said that they were satisfied with the

care received, however, only 46% intended on returning to

the same facility for future deliveries.

Conclusions Systematic implementation of quality

standards to mitigate these gaps in service readiness,

provision and experience of care is the next step to

accelerate the country’s progress in reducing the maternal

and neonatal deaths.