A forgotten priority

Maternal health service infrastructure

Weak health service infrastructure contributes to poor maternal health. Apart from inadequate skilled human resources, substandard infrastructure includes poor access to functioning equipment and a lack of essential drugs and supplies.

What are the challenges?

Scarcity of health workers is perhaps the most fundamental challenge to maternity and newborn services worldwide, but increasing the number and competency of skilled health professionals is not enough. To be effective, health workers need access to the right reliable equipment, essential drugs and supplies, and basic and comprehensive care facilities that are well maintained and effectively distributed.

Well documented problems with maternal health service infrastructure include:

• equipment available is ineffective or inappropriate
• technical support and training is insufficient to operate equipment
• up to a third of equipment is not in service or not formally installed
• a shortage of skilled maintenance personnel and a quick turnover of technical staff in the public sector
• a lack of tools and spare parts
• inadequate funds allocated for inputs, maintenance or replacement.

Essential drugs

Shortages of essential drugs are also a major constraint to delivering high quality maternal care and have contributed both directly and indirectly to the high number of maternal and newborn deaths and disabilities worldwide. In 2002 the World Health Organization estimated that at least one third of the world's population lacks access to essential drugs. In poorer areas of Asia and Africa this figure may be as high as one half. In addition, the geographical distribution and quality of drugs is variable. Also, inappropriate handling, storage and distribution can alter the quality of drugs leading to serious health consequences and wasted resources. Users can associate a lack of drugs with a poorer quality of care.

Facilities

Whilst the poor availability and accessibility of health facilities with appropriate services and effective referral systems is well known, the poor state of existing facilities is less discussed. Lack of maintenance has led to many existing health care facilities being in extreme disrepair. This requires the rebuilding of new facilities at a greater cost.

The facilities themselves can be further hampered by weak infrastructural systems such as water supply and electricity. Uninterrupted supplies of water and electricity to the operating suite are critical. Even a brief power cut resulting in a rise in temperature of a refrigerator could lead to the breakdown of a drug and loss of its potency.

Policy priorities

The restoration and renovation of facilities should be part of a package of improvements in maternal and newborn care. Upgrading out of use operating theatres in particular should be a priority. This requires emphasis on the operating cost of health facilities when planning their construction.

To ensure the availability of appropriate equipment and supplies at a reasonable cost, effective procurement systems and staff training programmes need to be put in place. A strong lead must be taken by ministries of health.

National lists of essential drugs are needed to improve the quality of care and to save funds on drug costs. In addition a national drug policy and supervision undertaken by specially trained pharmacy staff on stock management and adherence to standard treatment guidelines are key components of any strategy to improve the management and use of drugs.

Louise Hulton
Options, Cap House, 9-12 Long Lane, London, EC1A 9HA, UK
l.hulton@options.co.uk

See also

'Upgrading Obstetric Care at the Health Centre Level, Juaben, Ghana', International Journal Gynaecology and Obstetrics 59 (Supplement 2), pages S83-S90, by The Kumasi PMM Team, 1997

Medical Supplies and Equipment for Primary Health Care: A Practical Resource for Procurement and Management, Couldson: ECHO International Health Services Limited, by Manjit Kuar and Sarah Hall, 2004

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