In 2012, 166 facilities were surveyed that offered care during labour and delivery: 81 in Ethiopia, 60 in Uttar Pradesh and 25 in Gombe State. Of these, 11 facilities (7%) were excluded from the analysis because of missing data relating to presence of SBAs, availability of commodities or volume of deliveries. In 2015, a total of 305 similar facilities were surveyed: 78 in Ethiopia, 121 in Uttar Pradesh and 106 in Gombe State. Of these, 38 facilities (12%) were excluded from the 2015 analysis due to missing data as described above. The same sampling frames were used in 2012 and 2015, and changes in the sample size between years reflected a change in stakeholders’ priorities.
Number of deliveries in sampled facilities
In 2012 in Ethiopia, the 76 health facilities with complete data recorded 4,439 deliveries in the six months prior to being surveyed, a median of 42 deliveries per facility (Inter-Quartile Range (IQR) 19-78, Table 2). In 2015 a total of 19,278 deliveries were recorded in 78 health facilities in the six months prior to survey, raising the median to 238 per facility (IQR 141-355, p-value for difference in medians <0.001). In 2012 in Uttar Pradesh, 22,235 deliveries in 56 facilities were recorded in the six months prior to the survey, a median of 269 deliveries (IQR 16-695) per facility. In 2015, 38,217 deliveries were recorded in 88 facilities in six months, a median of 289 per facility (IQR 6-797, p-value for difference in medians = 0.864). In 2012 in Gombe State, 23 health facilities recorded a total of 1,575 deliveries in the six months prior to the survey, with a median of 57 deliveries per facility (IQR 15-90). In 2105, 101 facilities recorded 7,154 deliveries, with a median of 39 deliveries per facility in six months (IQR 9-85, p-value for difference in medians = 0.644).
Presence of Skilled Birth Attendants in sampled facilities
At least one SBA was present in 93% of surveyed facilities in Ethiopia in 2012 (95% Confidence Interval (CI) 85-97) and 97% in 2015 (95% CI 90-99, p=0.24. Uttar Pradesh had at least one SBA present in 96% of surveyed facilities in 2012 (95% CI 86-99) and 90% in 2015 (95% CI 81-95, p=0.15). In Gombe State at least one SBA was present in 52% of surveyed facilities in 2012 (95% CI 32-71), falling to 21% in 2015 (95% CI 14-30, p=0.003).
Readiness to perform four routine-care signal functions in sampled facilities
Tables 3 to 5 show, for Ethiopia, Uttar Pradesh and Gombe State respectively, the 12 commodities that contributed towards the four signal functions, and the proportions of sampled facilities where these were available and operational. The availability of these commodities was then combined with the presence of SBAs to determine the readiness of each facility to perform each routine care signal function.
In Ethiopia, the readiness to perform signal functions remained stable or improved between 2012 and 2015. In 2015, over 90% of sampled facilities had the required commodities for clean cord care and prophylactic uterotonics. Approximately half were ready to manage labour using a partograph; this showed the greatest improvement from 2012 when the proportion was 32% (95% CI 22-43). Approximately half of facilities could provide adequate infection control (for those that could not this was mainly due to inadequate supplies of clean running water). Overall the proportion of surveyed primary care facilities in Ethiopia which were ready to perform all four routine care signal functions increased from 22% (95% CI 14-33) in 2012 to 35% (95% CI 25-46) in 2015.
In Uttar Pradesh the availability of commodities also remained stable or improved between 2012 and 2015. In both years approximately three-quarters of surveyed facilities were ready to provide basic infection control and clean cord care. In 2015, only around one quarter were ready to manage labour using a partograph but this had increased substantially from 2012 due to increased availability of blank partographs and urine testing kits. In 2015, two-thirds had prophylactic uterotonics available. Overall, the proportion of primary facilities in Uttar Pradesh which were ready to perform the four routine care signal functions increased from 2% (95% CI 0.2-12) in 2012 to 23% (95% CI 15-35) in 2015.
In Gombe State, the picture was reversed. The availability of most commodities in health facilities fell between 2012 and 2015. The proportion of facilities with a supply of clean running water decreased from 74% (95% CI 52-88) in 2012 to 37% (95% CI 28-47) in 2015. These declines mirrored the fall in the proportion of facilities with an SBA present on the day of the survey and meant that no facilities were ready to perform all four signal functions in 2015, a fall from 17% (95% CI 7-39) in 2012.
Proportions of women delivering in facilities ready to perform routine care signal functions.
Figures 1 to 3 show, for each setting in 2012 and 2015, the proportion of all deliveries at sampled facilities in the six months prior to the surveys that took place in facilities ready to perform each signal function. In Ethiopia in 2012, 40% (95% CI 26-57) of primary facility deliveries in the six months prior to the survey took place in facilities that were ready to perform all four basic care signal functions at the time of the survey. This proportion was 43% (95% CI 31-56) in 2015. In Uttar Pradesh, the proportions of deliveries in primary facilities that were ready to perform all four signal functions were 4% (95% CI 0.6-24) in 2012 and 39% (95% CI 26-55) in 2015. In Gombe State, 25% (95% CI 6-66) of primary facility deliveries took place in facilities that were ready to perform all four signal functions, but by 2015 no women gave birth in a facility which was ready to perform all four functions at the time of the survey. Taken together, 64,649 deliveries were recorded in our three-country sample of primary care facilities in 2015, but just 23,425 (36%, 95% CI 27-47) occurred in facilities that could be considered ready to offer good quality routine maternal and newborn care.