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Good quality maternal and newborn care at primary health facilities is essential, but in settings with higher maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent.

This paper, authored by Keith Tomlin and others, looks at health facilities in three settings with high maternal mortality to assess their readiness to provide routine maternal and newborn care. The study also explored whether health facilities were able to provide good quality care. Surveys to this end were conducted in 2012 and 2015 to assess change over time.

The surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. At each facility the staffing, infrastructure and commodities were quantified. These formed components of four “signal functions” that described aspects of routine maternal and newborn care. A facility was considered ready to perform a signal function if all the required components were present. Readiness to perform all four signal functions classed a facility as ready to provide good quality routine care. From facility registers the authors counted deliveries and calculated the proportions of women delivering in facilities ready to offer good quality routine care.

Results from the study show that in Ethiopia the proportion of deliveries in facilities classed as ready to offer good quality routine care rose from 40%  in 2012 to 43% in 2015. In Uttar Pradesh, India, these estimates were 4% in 2012 and 39% in 2015, while in Nigeria they were 25% in 2012 and zero in 2015.

Improved facility readiness in Ethiopia and Uttar Pradesh arose from increased supplies of commodities, while in Nigeria facility readiness fell due to depleted commodity supplies and fewer Skilled Birth Attendants.


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Keith Tomlin

IDEAS Data Manager 2012 - 2017

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Dr Della Berhanu

Assistant Professor

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Dr Meenakshi Gautham

IDEAS India Country Coordinator and Research Fellow

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Dr Nasir Umar

IDEAS Nigeria Country Coordinator and Assistant Professor

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Professor Joanna Schellenberg

IDEAS Co-Principal Investigator and Professor

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Deepthi Wickremasinghe

Research Fellow

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Professor Tanya Marchant

IDEAS Principal Investigator and Professor