Percent of health facilities with skilled attendant (doctor, nurse or midwife) available 24 hours a day, 7 days a week
The percent of health care facilities in a country or specified area with at least one skilled attendant available 24 hours per day and seven days per week. Skilled attendants include midwives, doctors, and nurses midwifes trained in and capable of delivering the seven basic functions of emergency obstetric care (EmOC).
The seven basic EmOC service functions are (WHO et al., 2010):
- Administer parenteral antibiotics
- Administer uterotonic drugs (i.e. parenteral oxytocin)
- Administer parenteral anticonvulsants for preeclampsia and eclampsia
- Manually remove the placenta
- Remove retained products (e.g. manual vacuum extraction, dilation and curettage)
- Perform assisted vaginal delivery (e.g. vacuum extraction, forceps delivery)
- Perform basic neonatal resuscitation (e.g., with bag and mask)
A facility and the qualified staff are classified as functioning at the comprehensive EmOC level when they offer the seven signal functions plus surgery (e.g. caesarean) and blood transfusion. For further background on the signal functions for EmOC and guidelines on managing complications of pregnancy and childbirth, see WHO et al. (2010) and WHO (2003).
This indicator is calculated as:
(Number of facilities with at least one skilled attendant available 24 hours a day, 7 days a week / Total number of health care facilities in country or specified area ) x 100
Data from facility records and birth registers; specialized surveys; interviews with key informants. The data can be disaggregated by the type of facility (public, private, non-governmental, community based) and by other relevant factors such as districts and urban/rural location.
If targeting and/or linking to inequity, classify the facilities by location (poor/not poor) and disaggregate by location.
Facility records; birth registers; specialized surveys; interviews
This indicator measures access to quality EmOC services based on the availability of a skilled birth attendant at the facility. Most obstetric complications occur at the time of labor and delivery and skilled attendants have been trained to quickly recognize life-threatening complications and intervene in to save the mother’s life. However, if women attend facilities where at least one skilled attendant is not available at all times, the women may not receive the life-saving care or referrals they need. Only about 58 percent of deliveries worldwide take place in the presence of skilled attendants and, while many of these occur as home deliveries, there are facilities that do not have at least one skilled attendant on an around the clock basis. This deficiency is attributable to two main factors: 1) overall lack of skilled attendants and 2) poor distribution of skilled attendants, especially in rural areas and poor urban areas or slums. The UNFPA and international partners are addressing this problem by promoting the training of professionals and developing innovative programs to attract and retain skilled attendants in the areas of greatest need (UNFPA, 2004). Women’s access to basic and comprehensive EmOC services from skilled attendants is vital to achieving Millennium Development Goals #5. improve maternal health #4. reduce child mortality.
While this indicator measures access to care as the availability of skilled attendants at facilities, it does not address other barriers to access at EmOC facilities, such as travel time to location, stockouts of necessary drugs, or inadequate equipment and supplies. In addition, the indicator does not measure the competency of the skilled attendants, for example, if they know how to deal effectively with the range of obstetric complications or will make timely referrals to comprehensive EmOC facilities for procedures, such as caesarean surgery and blood transfusions.
access, health system strengthening (HSS), safe motherhood (SM), obstetric fistula (OF)
UNFPA, 2004, Program Manager’s Planning Monitoring and Evaluation Toolkit, Part II: Indicators for Reducing Maternal Mortality, New York: UNFPA. http://www.unfpa.org/monitoring/toolkit/Tool6_2.pdf
WHO, UNFPA, UNICEF, AMDD, 2010, Monitoring Emergency Obstetric Care: A handbook, Geneva: WHO. http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf
WHO, 2003, Managing Complications in Pregnancy and Childbirth: A guide
for midwives and doctors. Geneva: WHO. http://whqlibdoc.who.int/publications/2007/9241545879_eng.pdf