Signal functions for emergency obstetric care (EmONC) as an intervention for reducing maternal mortality: A survey of public and private health facilities in Lusaka district,Zambia

Abstract

Background: Between 2013 and 2014, Zambia‟s maternal mortality ratio was estimated at 398 maternal deaths per 100,000 live births. Successful aversion of deaths is dependent on effective use of signal functions-a clinical intervention- to treat direct obstetric complications. Staff must be trained and supplies and equipment must be valid and functional. There is minimal evidence of effectiveness of signal functions in urban settings as previous research has focused on rural settings. This research evaluates the availability, accessibility, usability and quality of signal functions for EmONC in public and private health facilities in Lusaka District. Methods: A descriptive cross-sectional study was conducted at 35 public and private health facilities providing maternal and newborn care in Lusaka district. The Service Availability and Readiness Assessment (SARA) tool was administered to health facility in-charges and quantified signal functions, infrastructure, equipment, supplies and human resources using the UN process indicators. Data on deliveries and complications were collected from registers from June 2013 to May 2014 and analysed using Stata Version 11 with statistical significance set at p<0.05. Results: Only 22 (37% public and 26% private) of the 35 health facilities surveyed provided maternal and newborn care 24 hours a day, seven days a week. Lusaka district had a high unmet need for Basic EmONC services with approximately 27 % and 23% of health facilities being classified as BEmONC and CEmONC, respectively. Minimal performance of some signal functions was not synonymous with compromised quality and was attributed to infrequency of occurrence of complications causing health facilities to vacillate in status between BEmONC and CEmONC. Conclusion: Pattern of availability and use of signal functions reveals the status of maternity care policies and practices and amendments of these policies can enhance performance of signal function.