Description
Introduction - Objectives: All women should have access to safe birthing facilities. These facilities must be well staffed, equipped, and open all hours. The World Health Organization prioritized emergency obstetric and newborn care (EmONC) to prevent maternal deaths and maternal mortality reduction is a core indicator of the Sustainable Development Goals. In 2014, Punjab developed a health reform roadmap to chart a course for improvements in health services for citizens. Functional, staffed facilities, providing 24/7 safe deliveries, and EmONC were fundamental. This descriptive research study from Punjab will provide elements essential to health care reform from 2014 to 2023, leading to a substantial increase in the number and readiness of EmONC centers throughout the province.
Methodology: In 2014, a team from Acasus and Punjab Ministry of Health, conducted a baseline assessment of 3100 health facilities in the 36 districts of Punjab Province. An independent monitoring unit (IMU) of 220 individuals, was tasked with visiting each facility monthly to collect data on staff presence, available medicines, equipment, operating hours, and electricity. The IMU used handheld devices to optimize use of real-time data. Data was analyzed and shared with provincial management. Standing meetings incorporating management routines were instituted: a weekly review with the Secretary of Health, monthly with the Chief Minister, then the Chief Minister held monthly stock take meetings with all district heads for accountability and decision making.
Results and Discussion: Data from the baseline assessment and 2015 monitoring visits revealed facilities lacked basic infrastructure: 36% had no electricity, 42% were without functional water/sewage, 28% of medications were not available, 34% of equipment was not operational and 83% of health facilities did not have drinking water. In 2014, 65% of births were attended by a skilled birth attendant (SBA) and 77 of 2400 Basic Health Units (BHU’s) were open 24 hours, 7 days a week (24/7). Medical officers were posted in 62% of facilities and of those 55% were present during IMU visits. By 2019, 1000 BHU facilities were open 24/7, 97% with EmONC capabilities. Medical officers were in 90% of primary facilities with 82% in attendance and 78% of births had an SBA present. Improvements in facility infrastructure increased, 99% of facilities had electricity, 98% had water, 97% sewage systems, and 94% had functioning equipment. In 2023, 1686 of 2400 BHU’s operate 24/7 and 91% provide EmONC.
This study provides evidence of rapid health infrastructure improvement. Meeting notes document budgeting, personnel, and procurement decisions made by MOH leadership using data and insight from the established management routines. Rapid progress occurred meeting basic facility needs, and funding increased as government saw substantial change. The health budget doubled between 2014 and 2017 from 67 to 141m PKR. Services available to pregnant women pre/post-delivery increased and were free of charge.
Conclusions: A roadmap, independent and internal evidence of health system status, clear analysis with key indicators provided evidence, a team that could facilitate and problem solve with management and political backing made positive change reality. These factors were and remain significant to success.
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