Process indicators for safe motherhood programmes: their application and implications as derived from hospital data...

Area of Science:

• Public Health
• Obstetrics and Gynecology
• Health Services Research

Background:

• Maternal mortality ratios are unreliable for monitoring obstetric care.
• Process indicators offer a viable alternative for assessing obstetric service availability and utilization.

Purpose of the Study:

• To evaluate the availability, use, and quality of obstetric care in five Nepalese districts using process indicators.
• To identify gaps in essential obstetric care (EOC) services.

Main Methods:

• Utilized process indicators to assess EOC facility adequacy and service utilization rates.
• Examined hospital birth proportions, met need for obstetric care, caesarean section rates, and case fatality rates.

Main Results:

• While comprehensive EOC facilities were adequate in most districts, none met minimum basic EOC standards.
• Hospital birth rates and 'met need' for obstetric care fell below minimum acceptable levels in most districts.
• Caesarean section rates varied, and a high case fatality rate was observed in one hospital, indicating significant underuse of services.

Conclusions:

• Process indicators revealed substantial underutilization of essential obstetric care services in Nepal.
• Findings stimulated national policy discussions and led to the development of safe motherhood interventions and monitoring strategies.