Abstract

Since 1983, CREDESA has worked with the population of the Ouidah district. A streamlined system of primary health care, training, and operational research has been gradually established. CREDESA has received other funds from IDRC to do research on the constraints and opportunities related to food security and revenue generation in the Ouidah subprefecture (prior phases) and to implement an information and documentation service for the researchers and the population (89-0240). This third phase will develop a streamlined health services system at the district level which ensures equity and delivery of the referral/recourse system and it will identify the factors which promote within the communities a commitment towards solving their health and development problems. A diversified strategy of result dissemination has been developed by the research team, which proposes to influence, as it has successfully done in the past, national health policy-making.

Post-Project Summary

Earlier phases of the project were supported under file numbers 89-0229 and 91-0144. This abstract is based on research for a doctoral thesis conducted as part of the project (see bibliography). The research focused on emergency obstetric care at two regional and two district referral hospitals. Using data collection tools designed and validated for the purpose, trained research assistants observed 449 emergency cases over a period of 7 months, interviewed emergency obstetric care providers, and inventoried supplies and equipment in the four hospitals. They elicited provider and patient perspectives on the quality of emergency obstetric care through structured interviews and group consensus (brainstorming). The quality of emergency obstetric care was measured according to the following criteria: adequacy of clinical management, timeliness of care, effectiveness of care, quality of interpersonal relations and availability of key procedures. The proportion of patients for whom the national standards of emergency obstetric care were met ranged from 0.9% to 34.4% (p<0.001) in the four hospitals. For immediate care within 20 minutes, the range was 10.2% to 24.6% (p<0.001); for definitive care within 120 minutes, the range was 15.2% to 63% (p<0.001). The case fatality rate was excessively high, ranging from 3.1% to 6.5% (p<0.001). The national target was 1%. The proportion of patients treated rudely by providers ranged from 3.1% to 31.1% (p<0.001). Emergency drugs, blood and supplies were inconsistently available. Most of the patients (87%) had been referred from a peripheral facility and as many as 47.2% were severely ill upon arrival. The most important factor affecting the quality of emergency obstetric care was waiting for drugs to be purchased for patients by relatives. Other significant factors were patient parity, referral status, severity of patient condition upon arrival and the experience of first- and second-line providers (midwives and physicians, respectively). The study highlighted a number of system, management and financial barriers to care at the referral level, including: hospital unprepared upon patient arrival; long waiting times for drugs; inconsistent presence of surgical personnel and anesthetists; inability to maintain a consistent supply of key drugs and supplies; and delayed patient arrival at the hospital.

Recipient Institution(s)