Emergency obsteric care : an intervention for reducing maternal mortality in Nepal

The magnitude of maternal mortality in Nepal and its disparity with similar statistics from the developed world and also other developing countries has been an issue among policy makers and health services program officials. Since maternal mortality is a serious public health concern in Nepal, it is intended to find out the critical factors relating to this issue. This thesis comprises mainly three parts: the essay, the proposal and the data exercise. In the essay I have identified the problems related to maternal health in Nepal and found that maternal mortality is very high in comparison to other developing countries as well as the developed countries. Maternal mortality and morbidity estimates in Nepal continue to be dramatically high largely because emergency obstetric care, especially in rural areas, are often deficient and inappropriate to women’s situation. Situation analyses and data collection on the functioning and use of facilities was conducted in Morang district of Nepal. Research methods included patient flow studies, inventories of drugs and supplies, and retrospective reviews of hospital records. Qualitative information was also collected through group discussion. This situation analysis was helpful for assessing health system factors contributing to maternal deaths. While there are numerous factors that contribute to maternal mortality, I focus on those that affect the interval between the onset of obstetrical complication and its outcome. If prompt, adequate treatment in provided, the outcome will usually be satisfactory; therefore, the outcome is most adversely affected by delayed treatment. Then I have discussed about the various solutions to the problem and found that implementation of emergency obstetric care at the level of primary health center is the appropriate solution to the problem. The proposal is focused on the implementation of EmOC in Morang Districe and evaluation of the ongoing process. In the data exercise, an evaluation research was conducted to find out how the implemented Emergency Obstetric Care (EmOC) service is functioning in Panathnikom district of Thailand This study strengthens the capacity of the Ministry of Health in Nepal, to design, implement EmOC in Primary Health Center and evaluate the ongoing process; informs the decision makers about the importance of maternal mortality and shares information on the most effective strategy to reduce it.