Evaluation of comprehensive emergency obstetric care in the Mampong District Hospital

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The study was undertaken to evaluate comprehensive emergency obstetric care at the Mampong District Hospital in Ashanti Region. It was a descriptive cross-sectional study with a sample size of 200 women who experienced pregnancy related complications. Ten health providers all from the Maternity Wing of the District Hospital were also interviewed. Both closed and open-ended questions were used in designing the questionnaire and interview guide in addition to a checklist for equipment, drugs, supplies and personnel in the facility. The interview guide was pre-tested and used to collect information from respondents using face-to-face interview. The respondents were selected using purposive sampling. The evaluation was made through the measuring of availability, accessibility, adequacy, effectiveness and utilization of CEMOC services. Information collected was analyzed and presented using tables, pie and bar charts. Findings revealed that there were competent and trained personnel even though they were not enough, and there were adequate essential drugs, equipment and supplies to meet the demand from the public. The study also revealed that 83.3% of the respondents were assisted by caesarean section, 14.7% through vacuum extraction and 2% by laparotornies. A large number of women from other districts in the region patronized the facility. From January to September 2003, the facility had supervised 1,271 normal deliveries and managed 791 complicated cases. Most of the women who went for assistance reported with problems ranging between hypertensive disorders, obstructed labour, abortion, retained products, twin deliveries, ectopic pregnancies and bleeding. The finding on accessibility revealed that it was not difficult for clients or patients to get to the facility; 92% of the respondents used public transport, 3.5% used their own cars and 4.5% used hospital ambulance. Again, 74% paid between ¢600,000 and ¢900,000.00 and 26% paid between 01 million and 013 million for cost of services at the facility. 98% of the respondents saw the cost as affordable whilst 2% claimed it was unaffordable. The research also revealed that when women with pregnancy related complications are sent to the facility they are treated and discharged without any being referred. All respondents were able to get their drugs and they were attended to between 5 and 15 minutes after getting to the facility. The case fatality rate at the facility for the period of study was 0.13%. This is an indication of effectiveness. From the above findings, the researcher concluded that CEMOC is highly patronized in the Maternal Wing due to the availability of trained personnel, drugs, equipment and supplies. Cost of services was affordable services provided were adequate and effective. The researcher therefore recommended that policy makers should ensure sufficient budget allocation for sustenance of the programme, and that there should be more trained personnel to reduce the current workload at the facility. An in-service training programme should be intensified for health personnel to enable them remain current. The health insurance scheme should be implemented in the district and clients should be encouraged to settle their debts in good time.
A thesis submitted to the Department of Community Health, School of Medical Sciences, in partial fulfilment of the requirements for the degree of Master of Science, 2004