PATHS Final programme report: "Togetherness in Health" the Enugu ...

Improving Maternal Health Services in EnuguA recent piece of research (Onah et al 2005) indicated that only about 40% of deliveries in EnuguState are attended to by skilled personnel in either public or private facilities. About 60% ofwomen depend on Traditional Birth Attendants (TBAs), religious homes, and other places thatlack skilled attendants for deliveries.Places of last delivery (from Onah et al 2005)Place where last delivery took place No SBA SBAs*At home 203 (18.5%)Church/prayer house/healing home 185 (16.9%)Traditional birth attendant 191 (17.4%)Maternity home/government health center** 96 (8.8%)General/mission/private hospital 54 (4.9%)Tertiary care (UNTH2/Parklane Specialist Hospital) 172 (15.7%)Private obstetrician 194 (17.7%)Total 675 (61.6%0 420 (38.4%)* SBA – Skilled Birth Attendant** Most of these births are not with SBAsIn 2006 it was estimated that out of a projected population of 654,917 women of reproductiveage, 163,729 (25%) would become pregnant. However, records show that only 11,414 (7%)women actually attended public health facilities that year for antenatal care (ANC). Also strikingis that of the estimated 130,983 deliveries in 2006, only 4,927 (4%) reportedly delivered in nontertiarylevel public health facilities in Enugu (HMIS, 2006 report). HMIS data also indicates thatvery few facilities have significant numbers of deliveries.All this information is critical in designing safe motherhood programmes.Health System - Institutional ArrangementsWhen PATHS began in 2002, the make up of public sector health facilities was the same as in otherstates. However, with the advent of the District Health System the public health service became aunitary system with single lines of accountability (for details see later). Five types of facilities wererecognised - health posts, health clinics, health centres, cottage hospitals, and district hospitals. Healthposts, health clinics and health centres deliver primary health care services. Cottage hospitals providelimited secondary care services and each District has a district hospital which is the locus of secondarycare. The exception to this is Enugu Municipality which lacks a district hospital.The minimum standard is that each district hospital will contain six units: Medicine, Surgery, Obstetricsand Gynaecology, Paediatrics, Diagnostic laboratory and Pharmacy. The district hospital is linked to all12 PATHS Final Programme Report