Profile of surveyed health facilities and volume of deliveries
Of the 42 public health facilities surveyed in the 3 HZs, 24 were health centres, all owned and managed by the state, and 18 were referral institutions, of which 5 were RHs and 13 were RHCs (Table 2). In the HZ of Goma, most referral facilities (5/6; 83%) were owned and managed by private non-for-profit organizations (NFPO) including 1 RH by the Catholic, 3 RHCs by Protestant churches, and 1 RHC by a non-governmental organisation. In the HZ of Karisimbi, half of referral facilities were non-for-profit organisations managed by Protestant churches. All referral facilities in the HZ of Rutshuru were state owned.
However, as part of the humanitarian response to conflict-related health crises, the RH of the HZ of Rutshuru was run by Médecins Sans Frontières (MSF), dating back to 2005. In this HZ, MSF built a maternity-waiting home and was providing, among other things, full exemption from user fees for CS and charging a flat-fee of USD 5 for vaginal deliveries. In 2016, 36.7% (4,578/12,462) of deliveries and 83% of CS (1491/1,797) in Rutshuru took place at its RH. Relatedly, in the HZs of Goma and Karisimbi, NFPO facilities attended 45,8% (10,459/22,821) of deliveries and 73.2% (2,446/3,337) of Cs in 2016.
Provision of signal functions
Only 17% (3/18) of the referral—which included 1 faith-based RHC and the government RH in Goma and 1 faith-based RHC in Karisimbi—provided the nine signal functions within the last 3 months prior to the survey and thus met the criteria for functioning cEmONC facilities (see Table 3). All the remaining (83%; 15/18) were partial cEmONC facilities (i.e., 8 or fewer signal functions provided). Of these, 20% (3/15) were short of one signal function (the provision of AVD) to qualified as functioning cEmONC facilities, which included 1 faith-based RHC and the government RH in Goma, and 1faith-based RHC in Karisimbi.
None of the health centres (HCs) qualified as basic EmONC or could offer EmONC services 24 hours, 7days a week (24/7). All the HCs in Rutshuru and 88% (7/8) of the HCs in Karisimbi performed only 1 to 3 signal functions of bEmONC during the last 3 months, whereas 80% (4/5) of the HCs in Goma performed 4 to 6 basic signal functions. Assisted vaginal delivery (AVD) was the least performed signal function (7.1%; 3/42), followed by parental administration of anticonvulsants (33.3%; 14/42) and neonatal resuscitation (45.2%; 19/42) (Table 3) .
Table 3
Signal functions performed by designated EmONC facilities per level in the 3 health zones (HZs) in the North-Kivu Province of Eastern Democratic Republic of the Congo (DRC), 2017
Health zones
|
#1.Antibiotics
|
#2.Oxytocics
|
#3.Anti-convulsants
|
#4. MRP
|
#5. RRP
|
#6. AVD
|
#7. Neonatal resuscitation
|
#8. Caesarean section
|
#9. Blood transfusion
|
Facilities performing all signal function*
|
Facilities providing services 24 hours a day and 7days a week
|
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
Goma
|
|
|
|
|
|
|
|
|
|
|
|
RH and RHC (n = 6)
|
6 (100)
|
6 (100)
|
6 (100)
|
6 (100)
|
6 (100)
|
2 (33.3)
|
6 (100)
|
6 (100)
|
5 (83.3)
|
2 (33.3)
|
6 (100)
|
HC (n = 5)
|
5 (100)
|
5 (100)
|
3 (60.0)
|
5 (100)
|
4 (80.0)
|
0 (0)
|
3 (60.0)
|
NA
|
NA
|
0 (0)
|
0 (0)
|
Karisimbi
|
|
|
|
|
|
|
|
|
|
|
|
RH and RHC (n = 6)
|
6 (100)
|
6 (100)
|
3 (50.0)
|
6 (100)
|
6 (100)
|
0 (0)
|
6 (100)
|
6 (100)
|
4 (66.7)
|
0 (0)
|
6 (100)
|
HC (n = 8)
|
5 (62.5)
|
8 (100)
|
0 (0)
|
8 (100)
|
2 (25.0)
|
0 (0)
|
1 (12.5)
|
NA
|
NA
|
0 (0)
|
0 (0)
|
Rutshuru
|
|
|
|
|
|
|
|
|
|
|
|
RH and RHC (n = 6)
|
3 (50.0)
|
6 (100)
|
2 (33.3)
|
5 (83.3)
|
5 (83.3)
|
1 (16.7)
|
2 (33.3)
|
4 (66.7)
|
1 (16.7)
|
1 (16.7)
|
4 (66.7)
|
HC (n = 11)
|
0 (0)
|
11 (100)
|
0 (0)
|
11 (100)
|
1 (9.1)
|
0 (0)
|
1 (9.1)
|
NA
|
NA
|
0 (0)
|
0 (0)
|
All HZs
|
|
|
|
|
|
|
|
|
|
|
|
RH and RHC (n = 18)
|
15 (83.3)
|
18 (100)
|
11 (61.1)
|
17 (94.4)
|
17 (94.4)
|
3 (16.7)
|
14 (77.8)
|
16 (88.9)
|
10 (56)
|
3 (16.7)
|
16 (88.9)
|
HC (n = 24)
|
10 (41.7)
|
24 (100)
|
3 (12.5)
|
24 (100)
|
7 (29.2)
|
0 (0)
|
5 (20.8)
|
NA
|
NA
|
0 (0)
|
0 (0)
|
Total (n = 42)
|
25 (59.5)
|
42 (100)
|
14 (33.3)
|
41 (97.6)
|
24 (57.1)
|
3 (7.1)
|
19 (45.2)
|
16 (88.9†)
|
10 (55.6†)
|
3 (7.1)
|
16 (38.1)
|
MRP: manual removal of placenta, RRP: removal of retained placenta, AVD: assisted vaginal delivery
|
HC: health centres, RHC: referral health centre, RH: referral hospital
|
* #1-#7 for HC and #1-#9 for R and RHC
|
†Calculated with the total number (n = 18) of RH and RHC as the denominator
|
NA: not applicable
|
Among facilities that could not performe AVD, ‘policy issue’ (i.e., HZ policies not allowing a signal function to be performed at targeted facilities) was the most frequently reported reason (74%; 29/39), mainly in facilities located in Rutshuru (88%; 15/17) and Karisimbi (71%; 10/14). ‘No indication’ (i.e., no patient needing this procedure came to the facility during the last 3 months) was the most frequently reported reason for not providing parental anticonvulsants (71%; 20/28) and neonatal resuscitation (70%; 16/23), followed by ‘policy issue’ in 18% (5/28) and 26% (6/23) of cases, respectively.
Further analyses showed that nearly all the facilities that reported ‘no indication’ for parenteral administration of anticonvulsants (95%; 19/20) didn’t provide this signal function even during the past 12 months. Also, 63% (10/16) and 50% (4/8) of facilities that didn’t provide neonatal resuscitation (NR) and AVD due to no indication, respectively, didn’t have the necessary equipment to perform these signal functions (i.e., neonatal bag and mask for NR and vacuum extractor or forceps for AVD).
Table 4
Distribution of EmONC facilities in the study health zones (HZs) in the North-Kivu Province of eastern Democratic Republic of the Congo (DRC) in comparison with the minimum number of facilities required by the World Health Organization (WHO), 2017
Health zones
|
Total population
|
Minimum number of EmONC facilities for 500,000 population as per the WHO†[a]
|
Number of designated cEmONC facilities for 500,000 population in the study HZs‡
|
Number of designated bEmONC facilities for 500,000 population in the study HZs‡
|
cEmONC facilities as per 500,000 population
|
bEmONC facilities as per 500,000 population
|
Functioning EmONC facilities as a proportion of the minimum number recommended by the WHO
([b + c]/a, %)
|
|
|
|
|
|
Minimum number acceptable by the WHO
|
Number of functioning cEmONC facilities in the study HZs [b]
|
Minimum number acceptable by the WHO
|
Number of functioning bEmONC facilities in the study HZs [c]
|
Goma
|
243,685
|
3
|
12
|
10
|
1
|
2
|
2
|
0
|
66.7
|
Karisimbi
|
461,089
|
5
|
7
|
9
|
1
|
0
|
4
|
0
|
0.0
|
Rutshuru
|
283,432
|
3
|
11
|
19
|
1
|
1
|
2
|
0
|
33.3
|
All HZs
|
988,206
|
10
|
9
|
12
|
2
|
3
|
8
|
0
|
30.0
|
cEmONC: comprehensive emergency obstetric and newborn care, bEmONC: basic emergency obstetric and newborn care
|
†Calculated as population/500,000 × 5 (rounded up)
|
‡Calculated as 500,000/population x number of designated EmONC or bEmONC facilities
|
Indicators of EmONC
Table 4 compares the minimum number of functioning EmONC facilities as per 500,000 population required by the WHO with the situation in the study HZs. The existing public health facilities designated to provide EmONC services exceeded considerably the minimum number of EmONC delivery points needed per 500,000 population in the 3 HZs. However, none of the health zones achieved the minimum number of functioning EmONC facilities as per the WHO recommendations, with an unmet need less pronounced in the HZ of Goma (Tables 4 and 5).
Overall, 14.3% (6,331/44,042) of births in 2016 occurred in functioning EmONC facilities (Table 5). In the HZ of Rutshuru, this proportion (35.2%; 4,578/13,009) was about twice as high as in the HZ of Goma (17.8%; 1,753/9,869). Deliveries in surveyed facilities in the 3 HZs (i.e., institutional deliveries) represented 80.1% (35,283/44,042) of births in 2016. In Goma, Karisimbi, and Rutshuru, the institutional delivery rate was 79.3% (7,824/9,869), 70.9% (14,997/21,164), and 95.8% (12,462/13,009), respectively (Table 5).
The proportion of MDOC managed in functioning EmONC facilities was only 3.1% (202/6,606) overall (Table 5). This proportion was 6.6% (97/1480) in the HZ of Goma and 5.4% (105/195) in the HZ Rutshuru. In contrast, the proportion of births by caesarean sections that took place in functioning EmONC facilities was 5.0% (2206/44,042) overall; 7.2% (715/9,869) in the HZ of Goma and 11.5% (1,491/13,009) in the HZ of Rutshuru. Caesarean sections in all RH and RHC surveyed (i.e., population based caesarean section rate [PCSR]) represented 11.7% (5,134/44,042) of births. In Goma, Karisimbi, and Rutshuru, the PCSR was 22.9% (2261/9,869), 5.1% (1,076/21,164), and 13.8% (1,797/13,009), respectively (Table 5).
With regards to the quality of EmONC, the direct obstetric case fatality rate (DOCFR) and the intrapartum and very early neonatal death rate (INDR) in EmONC facilities were 4.5% (9/202) and 1.9% (119/6,331), respectively (Table 5). The DOCFR in Goma was higher (5.2%;5/97) than that in Rutshuru (3.8%;4/105) and the INDR (1.2%;21/1753) about half of that in Rutshuru (2.0%;95/4578). When including all facilities surveyed, the INDR was 1.5% (532/35,283), with very little variation between the HZs, and the DOCFR was 5.1% (28/545). The highest DOCFR was in Karismbi (7.4%; 9/121). Major direct obstetric complications (MDOC) by causes and related maternal deaths in the 3 HZ are shown in Table 6.
Table 5
Indicators of EmONC in the study health zones (HZs) in the North-Kivu Province of Eastern Democratic Republic of Congo (DRC), 2016–2017
Indicators
|
Description*
|
HZ of Goma
|
HZ of Karisimbi
|
HZ of Rutshuru
|
Overall
|
|
|
MAL
|
LFF
|
DAF (n = 11)
|
MAL
|
LFF
|
DAF (n = 14)
|
MAL
|
LFF
|
DAF (n = 17)
|
MAL
|
LFF
|
DAF (n = 42)
|
Availability of functioning EmONC
|
At least 5 functioning EmONC facilities per 500,000 population including with at least 1 functioning cEmONC facility.
|
3
|
2
|
NA
|
5
|
0
|
NA
|
3
|
1
|
NA
|
10
|
3
|
NA
|
Proportion of all births in functioning EmONC facilities
|
Proportion of births in functioning EmONC facilities among expected number of births in a populationa
|
15%
|
17.8%
(1,753
/9,869)
|
79.3%
(7,824/
9,869)
|
15%
|
|
70.9%
(14,997/
21,164)
|
15%
|
35.2%
(4,578/
13,009)
|
95.8%
(12,462/
13,009)
|
15%
|
14.4%
(6,331/
44,042)
|
80.1%
(35,283/
44,042)
|
Met need for EmONC
|
Proportion of women with direct obstetric complications (DOC) treated in functioning EmONC facilities among all expected number of women with DOC b
|
100%
|
6.6%
(97
/1,480)
|
17.2% (254/
1,480)
|
100%
|
|
4.9%
(154/
3175)
|
100%
|
5.4%
(105/
1,951)
|
7.0%
(137/
1,951)
|
100%
|
3.1%
(202/
6,606)
|
8.3%
( 545/
6,606)
|
Caesarean sections as a proportion of all births
|
Proportion of caesarean section occurring in EmONC facilities among expected number of live births in a populationc
|
5–15%
|
7.2%
(715/
9,869)
|
22.9%
(2,261/
9,869)
|
5–15%
|
|
5.1%
(1,076/
21,164)
|
5–15%
|
11.5%
(1,491/
13,009)
|
13.8%
(1,797/
13,009)
|
5–15%
|
5.0%
(2,206/
44,042)
|
11.7%
(5,134/
44,042)
|
Direct obstetric case fatality rate (DOCFR)
|
Proportion of women with MDOC who died in EmONC facilities
|
< 1%
|
5.2%
(5/97)
|
4.7%
(12/254)
|
< 1%
|
|
7.4%
(9/121)
|
< 1%
|
3.8%
(4/105)
|
5.1%
(7/137)
|
< 1%
|
4.5%
(9/202)
|
5.1%
(28/545)
|
Intrapartum and very early neonatal death rate (INDR)
|
Proportion of births that result in a very early neonatal death or an intrapartum death among the births occurred in functioning EmONC facilities
|
‡
|
1.2%
(21/
1,753)
|
2.1% (167/
7,824)
|
‡
|
|
1.7% (258/
14,997)
|
‡
|
2.0%
(95/
4,578)
|
0.9%
(107/
12,462)
|
‡
|
1.9%
(119/
6,331)
|
1.5%
(532/
35,283)
|
*Source: Monitoring emergency obstetric care: a handbook. WHO, 2009 [26].
|
EmONC: emergency obstetric and newborn care, cEmNOC: comprehensive EmONC, MAL: minimum acceptable level, LFF: Level met by functioning facilities, DAF: data for all facilities
|
a Calculated as number of births in functioning EmONC/expected live births x 100 (for expected live birth see Table 2)
|
b Expected number of women with MDOC was calculated multiplying 15% with expected number of births in Table 2
|
c Calculated as number of CS/expected number of births x 100
|
‡ Not set
|
NA: not applicable, _: not calculated
|
Table 6
Causes of Major Direct Obstetric Complications (MDOC) and related deaths in the 3 health zones (HZ) in the North-Kivu Province of Eastern Democratic Republic of Congo (DRC), 2016
MDOC diagnosed in the facilities surveyed
|
Occurrences of MDOC by causes
n (%)
|
Deaths related
to MDOC
n (%)
|
Ante or postpartum haemorrhage
|
261 (47.9)
|
14 (50.0)
|
Retained placenta
|
6 (1.1)
|
1 (3.6)
|
Ruptured uterus
|
56 (10.3)
|
4 (14.3)
|
Postpartum sepsis
|
82 (15.0)
|
4 (14.3)
|
Severe pre-/eclampsia
|
95 (17.4)
|
3 (10.7)
|
Abortion complications
|
40 (7.3)
|
1 (3.6)
|
Ectopic pregnancy
|
5 (0.9)
|
1 (3.6)
|
Total
|
545 (100)
|
28 (100)
|
Staff, supplies and equipment for EmONC
The staff for EmONC available in the establishments surveyed consisted of nurses (63%; 325/519); medical doctors (25%; 30/519), of which 87% (113/130) were general practitioners and 13% (17/130) were specialists (obstetricians and paediatricians); and midwives (12%; 64/519) (Table 7). Of these, 59% (77/130) of medical doctors and 39% of midwives (25/64) were practicing in the HZ of Goma. Not-for-profit referral facilities in the HZs of Goma and Karisimbi together employed more midwives (83%; 24/29), specialists (75%;12/16), and maternity nurses (58%;58/102) than did government referral facilities. In the HZ of Rutshuru, 58% (14/24) of medical doctors were working at the referral hospital.
On average, there were fewer nurses on staff in the HCs located in the HZ of Rutshuru (median = 4, IQR = 2–5) than in those located the HZs of Goma (median = 7, IQR = 6–12) and Karisimbi (median = 7, IQR = 5–9). The average number of medical doctors in referral facilities was higher in the rural HZ of Goma (median = 9.5, IQR = 8–13) than in the HZs of Karisimbi (median = 3, IQR = 2–8) and Rutshuru (median = 2, IQR = 2–3) (Table 7).
Table 7 Availability of staff for emergency obstetric and newborn care (EmONC) services per level of facilities and per study health zones (HZ) in the North-Kivu Province of Eastern Democratic Republic of Congo (DRC), 2017
Health zones and facilities
|
Staff for EmONC services
|
|
All
|
Nurses n(%)
|
Midwives‡ n(%)
|
Medical doctors n(%)
|
|
|
Overall
|
519
|
325 (63)
|
64 (12)
|
130 (25)
|
|
|
|
|
|
Specialists†
|
General Practitioners
|
|
RH and RHC (n=18)
|
384
|
204 (63†)
|
50 (78†)
|
17
|
113
|
|
HC (n=24)
|
135
|
121 (37†)
|
14 (22†)
|
NA
|
NA
|
|
Median number per facility
|
_
|
6 (IQR=4-8)
|
2* (IQR=1.5-4)
|
3.5** (IQR=2-10)
|
|
Goma
|
198
|
96 (48)
|
25 (13)
|
77 (39)
|
|
RH and RHC (n=6)
|
163
|
63 (66†)
|
23 (92†)
|
16
|
61
|
|
HC (n=5)
|
35
|
33 (33†)
|
2 (8†)
|
NA
|
NA
|
|
Median number per facility
|
_
|
7 (IQR=6-12)
|
4* (IQR=2-4)
|
9.5** (IQR=8-13)
|
|
Karisimbi
|
150
|
102 (68)
|
19 (13)
|
29 (19)
|
|
RHC and RH (n=6)
|
105
|
63 (62†)
|
13 (68†)
|
0
|
29
|
|
HC (n=8)
|
45
|
39 (38†)
|
6 (32†)
|
NA
|
NA
|
|
Median number per facility
|
_
|
7 (IQR=5-9)
|
2* (IQR=1-3)
|
3** (IQR=2-8)
|
|
Rutshuru
|
171
|
127 (74)
|
20 (12)
|
24 (14)
|
|
RHC and RH (n=6)
|
116
|
78 (61†)
|
14 (70†)
|
1
|
23
|
|
HC (n=11)
|
55
|
49 (39†)
|
6 (30†)
|
NA
|
NA
|
|
Median number per facility
|
_
|
4 (IQR=3-5)
|
2* (IQR=1.5-3.5)
|
2** (IQR=2-3)
|
|
HC: health centres, RHC: referral health centres, RH: referral hospitals, IQR: interquartile range
|
|
†Percentages of cadres per level of facilities
|
|
‡Not available in 18 facilities (5 HCs in Goma, 5HCs in Karisimbi, 2 RHCs and 7 HCs in Rutshuru)
|
|
†Obstetricians and paediatricians
|
|
*In facilities with midwives (n=24)
|
|
**In RH and RHC only
|
|
NA: not applicable, _: not calculated
|
|
Regarding the availability of essential drugs, equipment in the facilities surveyed, magnesium sulphate was the least available drug in the facilities surveyed (45.2%;19/42). Vacuum extractors were the least available equipment (21.4%;9/42), followed by filled oxygen cylinders and neonatal intravenous fluid sets (Table 8). These drugs and equipment were more frequently unavailable in HCs located in the HZs of Karisimbi and Rutshuru. There was a pattern whereby essential drugs and equipment for EmONC were more likely to be available in facilities located in the HZ of Goma. In the HZ of Rutshuru, 33% (2/6) of the referral facilities, and 36% (4/11) of the HCs did not have an operational laboratory for lack of equipment or technicians.
Transport and communication systems for referral
Overall, 23.8% (10/42) of the facilities surveyed had an ambulance (car or motorcycle) on-site; nearly all of these were referral facilities, of which two thirds of the referral facilities in Rutshuru, and half of the referral facilities both in Goma and Karismbi (Tale 7). Similarly, 16% (26/42) of the facilities had a means of communication (cell phone or two-way radio) for referral purposes. The vast majority of them were referral facilities. All the referral facilities that had an operational ambulance on-site reported charging fees for its use when an institutional referral was requested in their respective HZs, except for the referral hospital of Rutshuru, whose ambulance was operational through MSF support.
Table 8
Availability of essential drugs, equipment, ambulance and communication means in the facilities surveyed in the 3 health zones (HZs) in the North-Kivu Province of Eastern DRC, 2017
Drugs, equipment and other infrastructures
|
All facilities
(n = 42)
|
HZ of Goma
|
HZ of Karisimbi
|
HZ of Rutshuru
|
RH and
RHC (n = 6)
|
HC
(n = 5)
|
RH and
RHC (n = 6)
|
HC
(n = 8)
|
RH and
HC (n = 6)
|
HC
(n = 11)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
n(%)
|
Drugs
|
Injectable beta-lactams
|
42 (100)
|
6 (100)
|
5 (100)
|
6 (100)
|
8 (100)
|
6 (100)
|
11 (100)
|
Injectable metronidazole
|
33 (78.6)
|
6 (100)
|
5 (100)
|
6 (100)
|
6 (75.0)
|
6 (100)
|
4 (36.4)
|
Magnesium sulphate
|
19 (45.2)
|
6 (100)
|
3 (60)
|
6 (100)
|
2 (25.0)
|
5 (83.3)
|
0 (0)
|
Diazepam
|
39 (92.8)
|
6 (100)
|
3 (60.0)
|
6 (100)
|
8 (100)
|
6 (100)
|
10 (90.9)
|
Anti-hypertensive drugs
|
26 (61.9)
|
6 (100)
|
2 (40.0)
|
6 (100)
|
6 (75.0)
|
5 (83.3)
|
1 (9.1)
|
Oxytocics
|
42 (100)
|
6 (100)
|
5 (100)
|
6 (100)
|
8 (100)
|
6 (100)
|
11 (100)
|
Crystalloid fluids
|
42 (100)
|
6 (100)
|
5 (100)
|
6 (100)
|
8 (100)
|
6 (100)
|
11 (100)
|
Equipment
|
Foetal stethoscope
|
42 (100)
|
6 (100)
|
5 (100)
|
6 (100)
|
8 (100)
|
6 (100)
|
11 (100)
|
Blood pressure cuff
|
42 (100)
|
6 (100)
|
5 (100)
|
6 (100)
|
8 (100)
|
6 (100)
|
11 (100)
|
Filled oxygen cylinder
|
12 (28.9)
|
6 (100)
|
0 (0)
|
3 (50.0)
|
0 (0)
|
3 (50.0)
|
0 (0)
|
Catheter for IV line
|
40 (95.2)
|
6 (100)
|
5 (100)
|
6 (100)
|
7 (87.5)
|
6 (100)
|
10 (90.9)
|
Uristix
|
26 (61.9)
|
3 (50.0)
|
2 (40.0)
|
6 (100)
|
5 (62.5)
|
6 (100)
|
4 (36.4)
|
Neonatal IV fluid set
|
22 (52.4)
|
6 (100)
|
3 (60.0)
|
6 (100)
|
3 (37.5)
|
4 (66.7)
|
0 (0)
|
Neonatal bag and mask
|
27 (64.3)
|
6 (100)
|
2 (40.0)
|
6 (100)
|
4 (50.0)
|
6 (100)
|
3 (27.3)
|
Kit for uterine evacuation
|
28 (66.7)
|
4 (66.7)
|
4 (80.0)
|
5 (83.3)
|
4 (50.0)
|
6 (100)
|
5 (45.5)
|
Aspirator
|
35 (83.3)
|
6 (100)
|
5 (100)
|
6 (100)
|
7 (87.5)
|
6 (100)
|
5 (45.5)
|
Vacuum extractor
|
9 (21.4)
|
6 (100)
|
1 (20.0)
|
1 (16.7)
|
0 (0)
|
1 (16.7)
|
0 (0)
|
Resuscitation table
|
35 (83.3)
|
6 (100)
|
4 (80.0)
|
6 (100)
|
8 (100)
|
6 (100)
|
5 (45.5)
|
Other infrastructures
|
|
|
|
|
|
|
|
Ambulance†
|
10 (23.8)
|
3 (50.0)
|
0 (0)
|
3 (50.0)
|
0 (0)
|
4 (66.7)
|
0 (0)
|
Communication means for referral‡
|
16 (38.1)
|
6 (100)
|
0 (0)
|
6 (1009
|
0 (0)
|
3 (50)
|
1 (9)
|
RH: referral hospital, RHC: referral health centre, HC: health centre, IV: intravenous
|
†Car or motorcycle
|
|
|
|
|
|
|
|
‡Cell phone or two-way radio
|
|
|
|
|
|
|
|