Exploring Barriers and Bridging Gaps: Perspectives of Nurses, Midwives, and Lady Health Workers in the Implementation...

Maternal mortality is a global concern primarily due to preventable obstetric complications. Challenges in implementing Emergency Obstetric Care (EmOC) in developing nations hinder effective reduction of these deaths. Our objective was to identify key challenges in EmOC practices among frontline healthcare providers, assess the severity and frequency of these barriers, and evaluate gaps in resources, training, and institutional support needed for effective resolution.

This cross-sectional study assessed EmOC knowledge, practical skills, and challenges among Nurses, Lady Health Visitors (LHVs), and Lady Health Workers (LHWs) in Khyber Pakhtunkhwa, Pakistan from July 2017-June 2020. Participants were conveniently sampled from hospitals across eight districts, with data collected through a questionnaire on EmOC knowledge, practical interventions, and challenges faced.

Although most participants (91% of nurses, 90.2% of LHVs, 92.3% of LHWs, and 83.3% of midwives) expressed satisfaction with course content, important gaps emerged in the practical application of specific EmOC interventions. Nurses displayed 79% knowledge of the Partogram with only 60% utilization, while LHVs showed 80.5% knowledge but just 50.2% utilization. Assisted delivery knowledge and practice were particularly low among nurses (32% & 7%) & LHVs (17.1% & 2.4%) respectively. Significant gaps were found in retained placenta removal and manual vacuum aspiration, with only 12% of nurses and 3% of LHVs practicing the latter, with no utilization among LHWs or midwives. Key barriers included insufficient training and restrictive institutional policies.

Despite high course content satisfaction, disparities in EmOC knowledge and practice persist among frontline healthcare-providers, with barriers like insufficient training and institutional limitations impacting maternal outcomes.