Table 1 Key findings and summary scores by module

CEmOC

BEmOC

A2. Infrastructure

Availability of electricity, back-up power supply, running water, soap/disinfectant, sharps disposal, fridge for drugs, oxygen source, complaints/ suggestions box

3 (42.8)

5 (71.4)

4 (57.1)

3 (60)

nd^a

3.8 (0.83)

4.3 (0.6)

3.8 (0.85)

A5. Health information & record keeping

Health info: reporting forms, monthly reports of OPD visits, computer based system for medical indicators, periodic facility review of stats and indicators

Records: clarity, legibility, availability, access

2 (28.6)

5 (71.4)

4 (57.1)

2 (40)

nd

3.8 (0.79)

4.0 (0.8)

3.7 (0.81)

A6. Essential drugs & blood products

List of essential drugs checked for presence, regular availability, expiry

Blood bank at facility, blood units available

2 (28.6)

6 (85.7)

1 (14.3)

3 (60)

2 (40)

3.8 (0.73)

4.3 (0.5)

3.7 (0.75)

A7. Laboratory

Various lab investigations observed: if test available, results readily available, average time to get results

3 (42.8)

3 (42.8)

2 (28.6)

4 (80)

nd

3.3 (1.06)

4.2 (0.4)

3.1 (1.06)

A8. Health facility policies

Policies checked for availability: hospital fees, free drugs, services for emergency cases, community participation, infection control, hand hygiene, in service training, quality of care, KMC, essential drugs list

2 (28.6)

2 (28.6)

5 (71.4)

4 (80)

nd

3.5 (0.74)

4.0 (0.0)

3.3 (0.79)

A9. Referral

Functioning vehicle with fuel routinely available for emergency referral use, referral transport provided free of charge, clear criteria for referral, communication with referral facility, referral time

1 (14.3)

7 (100)

4 (57.1)

4 (80)

nd

3.7 (1.13)

4.4 (0.9)

3.6 (1.15)

A10. Guidelines/ audit

Guideline availability for normal labour & delivery, emergency conditions for mothers, newborns and children, routine care for newborns, management of childhood illnesses, recent obstetric, neonatal and paediatric textbook

Conduct of audits to review deaths and complications (MDSR, neonatal, perinatal, paediatric), functioning of teams, recommendations discussed and implemented, periodic meetings to discuss issues and revise protocols

0 (0)

3 (42.8)

2 (28.6)

0 (0)

nd

2.6 (1.11)

3.5 (0.6)

2.4 (1.12)

CEmOC

BEmOC

B1. Emergency obstetric care

Patient flow, layout and structure of emergency care

0 (0)

6 (85.7)

3 (42.9)

3 (60)

1 (20)

3.4 (0.77)

3.2 (0.8)

3.5 (0.79)

B2. Maternity wards

Ward staffing, hygiene & accident prevention, attention to most seriously ill

0 (0)

6 (85.7)

2 (28.6)

2 (40)

1 (20)

3.2 (0.77)

3.0 (0.9)

3.3 (0.75)

B3. Infection control & supportive cares

Infection control: hand hygiene, use of gloves, infection control practices

1 (14.3)

5 (71.4)

0 (0)

0 (0)

0 (0)

3 (0.74)

3.2 (0.8)

3.0 (0.75)

Supportive care: nutritional needs of admitted patients, IV fluids, drug treatment, blood transfusion

3 (42.9)

5 (71.4)

4 (57.1)

5 (100)

5 (100)

4 (0.62)

3.8 (0.4)

4.1 (0.65)

B4. Essential drugs, equipment and supplies

Essential drugs: checked for presence, regular availability, expiry: water, normal saline. Ringers lactate, hydralazine/nifedipine, methyldopa, oxytocin, misoprostol, ergometrine, calcium gluconate, injectable MgSO4, diazepam, ampicillin/amoxycilin, benzylpenicillin, gentamycin, metronidazole, lignocaine 2% or 1%, halothane/isoflurane, ketamine

1 (14.3)

6 (85.7)

1 (14.3)

2 (40)

2 (40)

3.5 (0.87)

4.0 (1.0)

3.4 (0.85)

Equipment and supplies: checked for presence, safety, hygiene, good working order: lighting, exam light, wall clock, delivery pack, partographs, heat lamp, CS set, oxygen cylinder, concentrator, supply & flow metres and equipment for administration of oxygen, respiratory support bags, bags and masks (adult and neonatal size), anaesthetic equipment, thermometer, sterile gloves, sterile gauze, foetal stethoscope, stethoscope, BP machine, infusion sets & pumps, IV catheters, urinary catheter & bags, syringes, needles & cannulas, suture set, sharps container, vacuum extractor, vacuum aspirator, delivery, regular & operating beds, neonatal equipment

1 (14.3)

4 (57.1)

3 (42.9)

4 (80)

3 (60)

3.4 (0.73)

3.8 (0.4)

3.4 (0.77)

B5. Antepartum care

Eclampsia and pre-eclampsia: diagnosis, management of mild pre-eclampsia, management of severe pre-eclampsia and eclampsia

1 (14.3)

2 (28.6)

4 (57.1)

5 (100)

0 (0)

3.3 (0.77)

3.4 (0.5)

3.3 (0.82)

Infections during pregnancy: Antibiotic use inf pregnancy, screening and management of HIV in pregnancy, management of severe malaria in pregnancy

5 (71.4)

4 (57.1)

3 (42.9)

5 (100)

5 (100)

4 (0.54)

4.2 (0.4)

4.0 (0.58)

B5. Intrapartum & postpartum care

Normal labour and vaginal delivery: delivery conditions, supportive care throughout labour, care during first, second and third stage of labour, care of mother after delivery

1 (14.3)

5 (71.4)

4 (57.1)

1 (20)

2 (40)

3.5 (0.70)

3.0 (0.0)

3.6 (0.73)

Preterm labour: management of pre-term labour, antenatal administration of corticosteroids

2 (28.6)

3 (42.9)

1 (14.3)

1 (20)

4 (80)

3 (1.33)

4.3 (0.5)

2.6 (1.23)

Caesarean section (Assessed at 6 EmONC facilities only): emergency CS, timing of CS and informed consent, indications and policies to reduce inappropriate CS, procedures related to CS, immediate post-CS care, care after 24 h and discharge after CS

1 (50)

nd

1 (100)

1 (100)

1 (100)

3.6 (0.89)

3.5 (1.0)

nd

PPH guidelines available and known by SBAs, adequate equipment, drugs and personnel available, uterine tonus controlled after delivery, reliable way of measuring blood loss in delivery room and early puerperium, blood can be obtained without delay 24 h a day, written protocols available, known and used by staff for notification of on calls, treatment and resuscitation, uterine atony, and refractory haemorrhages after treatment

0 (0)

7 (100)

1 (14.3)

3 (60)

3 (60)

3.5 (0.97)

3.4 (0.5)

3.6 (1.06)

Unsatisfactory progress of labour: diagnosis of labour disorders, prolonged active phase management

6 (85.7)

7 (100)

3 (42.9)

5 (100)

5 (100)

4.2 (0.57)

4.2 (0.4)

4.2 (0.61)

Monitoring & follow up of admitted patients: monitoring of individual progress, reassessment by midwives, reassessment by clinicians, follow up

1 (14.3)

6 (85.7)

3 (42.9)

4 (80)

3 (60)

3.6 (1.0)

3.5 (0.8)

3.6 (1.09)

CEmOC

BEmOC

C1. Nursery facilities

Ward staffing, hygiene & accident prevention

0 (0)

4 (57.1)

5 (71.4)

3 (60)

1 (20)

3.2 (1.19)

3.5 (0.8)

3.1 (1.3)

C2. Infection control & supportive care

Infection control and hygiene, use of gloves, infection control practices

2 (28.6)

4 (57.1)

3 (42.9)

0 (0)

0 (0)

3.3 (0.93)

3.2 (0.4)

3.6 (1.06)

Supportive care: IV fluids use, drug treatment, central venous cannulation & umbilical catheterization, blood transfusion

0 (0)

2 (28.6)

5 (71.4)

2 (40)

0 (0)

3.5 (0.83)

3.7 (1.2)

3.5 (0.65)

C3. Essential drugs, equipment & supplies

Essential drugs checked for presence, regular availability, expiry: antibiotics, antivirals and antifungals, CNS drugs, respiratory drugs, miscellaneous including chlorhexidine, paracetamol suspension, nevirapine suspension, vitamins & minerals

3 (42.9)

3 (42.9)

5 (71.4)

2 (40)

1 (20)

3.4 (1.0)

4.0 (0.0)

3.2 (1.17)

Equipment and supplies checked for presence, safety, hygiene, good working order: incubators, radiant warmers, baby cots, phototherapy lamps, ambu bag, oxygen supply, concentrator & nasal prongs, appropriate sized face masks, CPAP systems, multifunction monitors, pulse-oximeters, breast pumps, nasogastric tubes, microdroppers, exchange transfusion, stethoscope, glucometers and sticks, suction apparatus, thermometers, electric weighing scale, linen

1 (14.3)

2 (28.6)

2 (28.6)

2 (40)

0 (0)

2.9 (0.95)

3.3 (0.8)

2.8 (0.98)

C4. Routine care

Neonatal resuscitation, assessment & immediate care, screening, prevention & management of infectious diseases, early & exclusive breastfeeding, monitoring before discharge, counselling for mothers

1 (14.3)

2 (28.6)

7 (100)

5 (100)

0 (0)

3.7 (0.70)

3.5 (1.0)

3.81 (0.54)

C5. Management of sick newborn

Management of preterm and LBW babies, neonatal sepsis, recognition & treatment of jaundice, management of convulsions, feeding for sick neonates

0 (0)

1 (14.3)

3 (42.9)

1 (14.9)

0 (0)

3.2 (0.93)

3.2 (1.2)

3.2 (0.75)

CEmOC

BEmOC

D1. Emergency paediatric care

Patient flow, emergency care staffing, layout & structure of emergency care, case management of emergency conditions

0 (0)

4 (57.1)

1 (14.9)

0 (0)

3 (60)

3.2 (0.69)

3.4 (0.9)

3.1 (0.64)

D2. Paediatric wards

Staffing level, hygiene & accident prevention, attention to most seriously ill patients

0 (0)

1 (100)

1 (100)

nd

nd

3.2 (0.96)

3.3 (1.0)

nd

D3. Infection control & supportive care

Infection control: Hand hygiene, use of gloves, practices for infection control

0 (0)

0 (0)

5 (71.4)

0 (0)

3 (60)

3.2 (0.60)

3.4 (0.5)

3.2 (0.62)

Supportive care: Nutritional needs, use of IV fluids, drug treatment, blood transfusion

5 (71.4)

4 (57.1)

7 (100)

4 (80)

2 (40)

4.2 (0.66)

2.6 (0.9)

2.8 (1.11)

D4. Essential drugs, equipment & supplies

Essential drugs checked for presence, regular availability, expiry: glucose (30–50%, 10%, 5%), saline, ringers lactate, half strength darrows, RESOMOL, adrenaline, corticosteroids IV or oral, furosemide IV, first line anticonvulsant, antibiotics, anti-malarials, paracetamol (oral, suppository), vitamin K, ORS, zinc sulphate

3 (42.9)

3 (42.9)

3 (42.9)

2 (40)

3 (60)

3.5 (0.76)

3.4 (0.5)

3.5 (0.81)

Equipment and supplies checked for presence, safety, hygiene, good working order: resuscitation table, torch, autoscope, scales for children, measuring board, stethoscope, thermometer, heat source, oxygen cylinder, concentrator & supply, oxygen flow meter, supplies for oxygen administration, resuscitation bags, IV sets, infusion pumps, burettes, cannulas/butterflies paediatric size, feeding syringes, NG tubes

0 (0)

1 (14.9)

2 (28.6)

0 (0)

2 (40)

2.7 (1.1)

2.6 (0.9)

2.8 (1.11)

D5. Case management of common diseases

Cough/difficult breathing: assessment & treatment of pneumonia, administration of antibiotics, administration of oxygen therapy, use of chest x-ray, management of wheezing, TB treatment

1 (14.9)

1 (14.9)

2 (28.6)

4 (80)

2 (40)

3.4 (0.91)

3.2 (0.4)

3.5 (1.0)

Diarrhoea: assessment of dehydration, management of dehydration & diarrhoea, antibiotic use, continued feeding

3 (42.9)

2 (28.6)

5 (71.4)

4 (80)

3 (60)

3.7 (0.68)

3.4 (0.5)

3.8 (0.7)

Fever: differential diagnosis & investigations, diagnosis & management of meningitis, diagnosis & management of severe/complicated malaria, diagnosis & management of measles, diagnosis & management of other severe febrile conditions

1 (14.9)

3 (42.9)

7 (100)

4 (80)

4 (80)

3.8 (0.62)

3.6 (0.5)

3.9 (0.64)

Malnutrition: assessment of nutritional status, management of infection & micronutrient supplementation, management of dehydration, prevention & management of hypoglycaemia & hypothermia, feeding of severely malnourished children, management of associated conditions & supportive care

4 (57.1)

0 (0)

6 (85.7)

4 (80)

4 (80)

4 (0.59)

3.8 (0.4)

4.0 (0.63)

HIV/AIDS: counselling & diagnosis of paediatric HIV/AIDS, ARV treatment and monitoring, opportunistic infections & supportive care, supportive care & follow up of HIV infected children

3 (42.9)

3 (42.9)

6 (85.7)

4 (80)

3 (60)

4.3 (0.66)

3.7 (0.6)

4.4 (0.62)

D5. Monitoring & follow up of admitted children

Monitoring of individual progress, monitoring by nurses, reassessment by clinicians, follow up

1 (14.9)

0 (0)

6 (85.7)

2 (40)

2 (40)

3.8 (1.0)

2.6 (0.5)

4.2 (0.86)

D6. Paediatric surgery & rehabilitation

Paediatric size anaesthesia-equipment, pre-, intra- and post-operative care, rehabilitation

nd

nd

nd

nd

0 (0)

3.5 (0.70)

3.5 (0.7)

nd