Emergency obstetric and newborn care signal functions: The situation in health facilities in Nepal between 2015 and 2021

Figures & data

Table 1. Signal functions for BEmONC and CEmONC services.

Signal functions	BEmONC	CEmONC
(i) Parenteral administration of antibiotics	Yes	Yes
(ii) Parenteral administration of uterotonics	Yes	Yes
(iii) Parenteral administration of anticonvulsants	Yes	Yes
(iv) Assisted vaginal delivery	Yes	Yes
(v) Manual removal of placenta	Yes	Yes
(vi) Manual removal of retained products	Yes	Yes
(vii) Neonatal resuscitation	Yes	Yes
(viii) Cesarean delivery		Yes
(ix) Blood transfusion		Yes

Source. Monitoring emergency obstetric care: a handbook, WHO (2009).

Table 2. Definition and measurement of variables.

Variables	Definition	Calculations
BEmONC signal function availability	Each of the seven individual signal functions have ever been performed by the service providers within the designated BEmONC site.	For each of the seven signal functions, coded “1” when the signal function characteristic of a BEmONC site has ever been performed, coded “0” if otherwise.
Overall BEmONC availability	All seven signal functions have ever been performed by the service providers within the designated BEmONC site.	A composite index was created, which is coded “1” when all seven signal functions characteristic of a designated BEmONC site have ever been performed, and “0” if otherwise.
CEmONC signal function availability	Each of the nine individual signal functions have ever been performed by the service providers within the designated CEmONC site.	For each of the nine signal functions, coded “1” when the signal function characteristic of a CEmONC site has ever been performed, coded “0” if otherwise.
Overall CEmONC availability	All nine signal functions have ever been performed by the service providers within the designated CEmONC site.	A composite index was created, which is coded “1” when all nine signal functions characteristic of a designated CEmONC site have ever been performed, and “0” if otherwise.
BEmONC signal function functionality	Each of the seven individual signal functions have been performed by the service providers within the designated BEmONC site in the last three months prior to the data collection day.	For each of the seven signal functions, coded “1” when the signal function characteristic of a BEmONC site has been performed in the last three months, coded “0” if otherwise.
Overall BEmONC functionality	All seven individual signal functions have been performed by the service providers within the designated BEmONC site in the last three months prior to the data collection day.	A composite index was created, which is coded “1” when all seven signal functions characteristic of a designated BEmONC site have been performed in the last three months, and “0” if otherwise.
CEmONC signal function functionality	Each of the nine individual signal functions have been performed by the service providers within the designated CEmONC site in the last three months prior to the data collection day.	For each of the nine signal functions, coded “1” when the signal function characteristic of a CEmONC site has been performed in the last three months, coded “0” if otherwise.
Overall CEmONC functionality	All nine individual signal functions have been performed by the service providers within the designated CEmONC site in the last three months prior to the data collection day.	A composite index was created, which is coded “1” when all nine signal functions characteristic of a designated CEmONC site have been performed in the last three months and “0” if otherwise.

Table 3. Weighted distribution of designated CEmONC and BEmONC sites in the total samples of NHFS 2015 and 2021.

Sites by managing authority and health facility types	2015		2021
	Number	Percent	Number	Percent
Total BEmONC sites	26	100	43	100
Public	26	100	42	97.7
Hospitals	4	15.8	7	17.6
Primary health care centers (PHCCs)	21	78.8	23	53.4
Basic health care centers (BHCCs)	1	4.6	12	27.9
Private hospitals	0	0	1	2.3
Total CEmONC sites	21	100	52	100
Public	13	63.8	26	50.0
Hospitals	13	63.8	25	49.0
Primary health care centers (PHCCs)	0	0	1	1.0
Private hospitals	8	36.2	26	50.0

Figure 1. (a) Availability of signal functions at BEmONC sites in 2015 and 2021. (b) Functionality of signal functions at BEmONC sites in 2015 and 2021.

Table 4. Distribution of BEmONC sites by difference in signal functions availability and functionality in Nepal in 2015 and 2021.

Signal functions	2015			2021
	Availability (%)	Functionality (%)	Difference (%)	Availability (%)	Functionality (%)	Difference (%)
Administration of parenteral antibiotics	80.4	61.5	18.9	72.8	47.0	25.8
Administration of parenteral oxytocin	97.6	93.7	3.9	89.5	79.9	9.6
Administration of parenteral anticonvulsants	56.6	11.8	44.8	57.5	11.0	46.5
Assisted vaginal delivery	54.4	25.2	29.2	28.5	9.5	19.0
Manual removal of placenta	85.9	59.1	26.8	68.8	35.3	33.5
Removal of retained products of conception	72.5	50.5	22.0	74.0	34.1	39.9
Neonatal resuscitation	89.8	63.7	26.1	81.0	44.1	36.9
All 7 (overall) signal functions	29.2	3.9	25.3	15.9	2.2	13.7
Total BEmONC sites	26	26	–	43	43	–

Figure 2. (a) Availability of signal functions at CEmONC sites in 2015 and 2021. (b) Functionality of signal functions at CEmONC sites in 2015 and 2021.

Table 5. Distribution of CEmONC sites by difference in signal functions availability and functionality in Nepal in 2015 and 2021.

Signal functions	2015			2021
	Availability (%)	Functionality (%)	Difference (%)	Availability (%)	Functionality (%)	Difference (%)
Administration of parenteral antibiotics	87.0	91.9	−4.9	93.8	91.7	2.1
Administration of parenteral oxytocin	93.7	100	−6.3	95.4	96.5	−1.1
Administration of parenteral anticonvulsants	75.1	59.7	15.4	87.6	64.7	22.9
Assisted vaginal delivery	84.1	73.5	10.6	85.7	56.2	29.5
Manual removal of placenta	85.0	78.8	6.2	92.2	71.2	21.0
Removal of retained products of conception	80.4	83.5	−3.1	90.3	76.8	13.5
Neonatal resuscitation	87.0	82.6	4.4	92.7	73.4	19.3
Blood transfusion	93.9	76.9	17.0	96.4	80.3	16.1
Cesarean delivery	92.9	79.9	13.0	98.9	93.0	5.9
All 9 (overall) signal functions	61.3	35.2	26.1	70.1	27.9	42.2
All seven signal functions (BEmONC)	21.4	8.7	12.7	45.5	17.4	28.1
Total CEmONC sites	21	21	–	52	52	–

World Health Organization (WHO). (2009). Monitoring emergency obstetric care: A handbook. World Health Organization.

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