With the West Demerara Regional Hospital being the only public facility providing basic Emergency Obstetric and Newborn Care (EmONC), a new report recommends the upgrade of government-run hospitals performing deliveries in order to boost maternal and newborn care.
The report was launched yesterday under the theme “Universal Access to Repro-ductive Health Services,” at the Ocean View Convention Centre, East Coast Demerara, to coincide with World Population Day.
The report, which gives a detailed assessment of all maternity facilities in Guyana during the year 2010, was supported by non-governmental organisations such as the United Nations Population Fund (UNFPA), the Pan American Health Organisa-tion (PAHO) and the United Nations Children’s Fund (UNICEF), among others. It was done to determine the capacity to conduct emergency lifesaving functions at the facilities as part of a wider series of initiatives to achieve universal access to reproductive health services, in keeping with the 2015 Millennium Development Goals (MDGs).
UNFPA representative Patrice La Fleur, in a brief overview of the report, said that when its recommendations are fully implemented, they will ensure that access to reproductive health services is universal, that the facilities and equipment are in place at the maternity health facilities, that contraceptive prevalence rate will increase and “ultimately less women or no woman should die” giving birth.
The report noted that according to internationally-accepted standards, Guyana does not have an adequate number of EmONC facilities, and that owing to logistics access to appropriate levels of care can be difficult.
It said although there are an adequate number of medical facilities, those which perform deliveries did not have the full infrastructure and staff competencies to be considered fully functioning EmONC facilities. As a result, it recommends that a five-year plan be developed to upgrade the facilities available. “The Ministry of Health must set its own standards (no less than the international standards) based on not only the population size but also its distribution. We recommend the development of a [five] year plan that identifies the facilities to be upgraded… The relevant financial resources must be allocated in the annual budget of the Ministry,” the report said.
Among the other findings was that although basic medicines were known to be vital during delivery, some health facilities had a small stock or none at all on hand. “Misoprostol was available in only 4% of the public health facilities and magnesium sulphate in only 65% of hospitals …if these drugs are considered essential then they must be available at all institutions” the report said.
In addition, it recommended an upgrade of record keeping and an investigation to determine why some women would prefer to travel long distances to the city public health care facilities for delivery.
There are nine signal functions required for a hospital to be termed a fully functioning EmONC facility, with a basic or comprehensive classification. Basic facilities are required to perform seven of the nine signal functions: administer parenteral antibiotics, administer parenteral anticonvulsants for severe pre-Eclampsia or Eclampsia; administer parenteral uterotonic drugs; perform manual removal of the placenta; removal of retained products; perform assisted vaginal delivery, with a vacuum extractor or forceps; and perform basic neonatal resuscitation with bag and mask. Comprehensive facilities, meanwhile, perform basic functions as well as surgeries such as Caesarean-sections and blood transfusions.
EmONC indicators, according to the report, are important not only in assessing the strength of the health system in delivering life saving intervention for both mothers and babies but in monitoring the progress towards reduction in maternal and newborn mortality.
Stating that this country’s maternal mortality is a strong indicator of the functioning of the health system, Dr. Janice Woolford, Director of the Maternal and Child Health Department at the Ministry of Heath, said that compared to Caribbean countries, Guyana’s maternal mortality figure is high, while noting that the vast majority of maternal deaths not only in Guyana but worldwide was preventable. The report also highlighted the fact that 42% of all maternal deaths are linked to indirect causes such as Malaria, Hepatitis, Anaemia, HIV/AIDS, Cardiovascular Disease, Chronic Non-Communicable Disease and Accidents.
Woolford noted that the report recommends that EmONC facilities be available to mothers countrywide as a means of bringing the figure down. Based on the population distribution and the recommendations for minimum acceptable levels, it said that there should be seven EmONC facilities on the coastland, at least two of which should be comprehensive, and one of the same in the hinterland. This is so that all births take place in, or near to a facility in which obstetric complications can be treated should they arise.
The report also noted that training of medical personnel is an integral part in lowering the maternal mortality figure and identified a lack of knowledge of midwives in dealing with maternal-related complications. “There is a deficiency in the knowledge of midwives in identifying and dealing with early neonatal complications. Of specific importance is being able to identify asphyxia in the newborn and knowing how to resuscitate. All health workers in the delivery area must be proficient in this procedure,” it said.
In addition, it was found that doctors acting as obstetricians and gynecologists were not certified as same. “Doctors currently providing obstetric and genealogical services are not obstetrician/gynecologists. It is recommended that formal training and certification in obstetrics be provided at least for those doctors who staff those health facilities designated as comprehensive EmONC facilities,” the report said.
Health centres were also found to be in need of nurses and medex and some categories of staff were found to be undertaking procedures which are not included in their training manual.
“All categories of staff involved in emergency care should be trained in at least basic EmONC.
It also noted that partographs, a tool developed by the World Health Organization (WHO) to monitor, document and manage labour, were found in half of the facilities surveyed but less than a third used them. Noting that partographs give a complete picture of maternal and fetal well-being and labour progress at a glance as well as guidelines on when labour is no longer normal, the report recommended that a policy should be put in place for routine use.
