Availability and readiness of health facilities to provide emergency obstetric care in eight low- and lower-middle-income countries: insights from nationally representative health facility surveys

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BACKGROUND: Despite progress in reducing global maternal mortality in recent decades, low- and lower-middle-income countries (LLMICs) continue to face major challenges. To reduce preventable maternal deaths, the WHO recommends emergency obstetric care (EmOC) in health facilities (HFs). However, up-to-date multi-country evidence on availability and readiness in LLMICs remains very limited. Hence, we analysed EmOC service availability and readiness in HFs across eight LLMICs. METHODS: We did a multi-country facility-based analysis of data from nationally representative Service Provision Assessment (SPA) surveys conducted between 2014 and 2022 in eight LLMICs (Afghanistan, Bangladesh, Democratic Republic of the Congo, Ethiopia, Haiti, Nepal, Senegal and Tanzania). A total of 4,382 facilities offering normal delivery services were included in the analysis. Service availability was assessed using seven signal functions for basic EmOC (BEmOC) with an additional two for comprehensive EmOC (CEmOC). The readiness score was calculated across three equally weighted domains-staff training and guidelines, essential equipment and supplies and essential medicines, resulting in a total score of 100. Descriptive statistics and multivariable regression were used to analyse the data. RESULTS: The average availability of BEmOC services was 13%, ranging from 2% in Nepal to 47% in Ethiopia. For CEmOC, average availability was 5%, ranging from 2% in Nepal to 19% in Afghanistan. Among facilities providing caesarean delivery services, 11% lacked blood transfusion services on average-this was highest in Bangladesh (20%), followed by Tanzania (12%) and Afghanistan (11%). Overall, the mean EmOC readiness score was 47, ranging from 40 in Tanzania to 60 in Ethiopia. CONCLUSION: The availability of BEmOC and CEmOC services and the related readiness of HFs were low. This study reveals critical gaps in selected LLMICs, including where facilities perform caesarean deliveries without having blood transfusion services. If not addressed, these gaps will limit the contribution of EmOC to reducing maternal mortality in LLMICs.

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