Do current maternal health staffing and bed occupancy benchmarks work in practice? Results from a simulation model

Area of Science:

• Healthcare Management
• Public Health
• Maternal Health

Background:

• The World Health Organization (WHO) aims to reduce maternal mortality by two-thirds by 2030.
• Low-income settings face challenges with high birth rates and limited medical resources.
• Ensuring quality intrapartum and postpartum care necessitates efficient resource and staff utilization.

Purpose of the Study:

• To evaluate if WHO resourcing benchmarks are adequate for consistent quality of care.
• To model the impact of birth seasonality on healthcare facility resource needs.
• To apply the model to real-world data from Emergency Obstetric Care (EmOC) facilities in Zanzibar.

Main Methods:

• Utilized a stochastic, individual-based model simulating deliveries over a year.
• Assigned random presentation times and durations of stay for simulated patients.
• Applied the model to 2014 Emergency Obstetric Care (EmOC) data from Zanzibar, Tanzania.

Main Results:

• Smaller EmOC facilities were often underutilized, while larger ones risked falling below recommended staff-to-patient ratios.
• Bed capacity was rarely exceeded, primarily affecting smaller Basic EmOCs (BEmOCs).
• Staffing capacity (skilled birth attendants to women in labor ratio) was exceeded nearly 50% of the time in larger Comprehensive EmOCs (CEmOCs).

Conclusions:

• Increasing staffing at CEmOCs and potentially reducing the number of small BEmOCs could enhance care quality.
• Upgrading BEmOCs may encourage their use, thereby alleviating pressure on CEmOCs.
• Ensuring timely access to EmOCs for all women remains critical for improving maternal health outcomes.