Alisa Pedrana1, Maya Tholandi2, Siti Nurul Qomariyah2, Reena Sethi3, Anne Hyre2, Dwirani Amelia4, Stephanie Suhowatsky5, Saifuddin Ahmed6. 1. Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia. 2. Jhpiego Indonesia, Jakarta, Indonesia. 3. Jhpiego, Baltimore, MD, USA. 4. Research and Development Unit, Budi Kemuliaan Health Institute, Jakarta, Indonesia. 5. Jhpiego Nepal, Kathmandu, Nepal. 6. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Abstract
OBJECTIVE: To describe doctors' and specialist physicians' availability to manage obstetric complications in hospitals in six provinces of Indonesia. METHODS: Data from a nonrandomized, quasi-experimental pre-post evaluation study were used to describe the distribution of providers by each cadre of worker and assess the availability of doctors and obstetrician/gynecologists (ob/gyns) for consultations for women experiencing postpartum hemorrhage or pre-eclampsia/eclampsia, disaggregated by hospital type, province, referral status, and by time of day of provider consultation. RESULTS: Among hospitals that should have comprehensive emergency obstetric and newborn care (CEmONC) services available 24 hours a day, 7 days a week, many did not have a doctor available to manage obstetric complications as they presented, despite there being an average of seven ob/gyns and four doctors registered for service across all facilities. Slightly over 50% of obstetric emergency cases admitted with postpartum hemorrhage and severe pre-eclampsia/eclampsia did not receive a consultation from an ob/gyn. Among the patients who received consultations, about 70% received consultations by phone or SMS. CONCLUSION: Findings from this study indicate that persistent issues of maldistribution of maternal and newborn specialists and high absence rates of both doctors and ob/gyns at CEmONC hospitals during obstetric emergencies undermines Indonesia's efforts to reduce high maternal mortality rates.
OBJECTIVE: To describe doctors' and specialist physicians' availability to manage obstetric complications in hospitals in six provinces of Indonesia. METHODS: Data from a nonrandomized, quasi-experimental pre-post evaluation study were used to describe the distribution of providers by each cadre of worker and assess the availability of doctors and obstetrician/gynecologists (ob/gyns) for consultations for women experiencing postpartum hemorrhage or pre-eclampsia/eclampsia, disaggregated by hospital type, province, referral status, and by time of day of provider consultation. RESULTS: Among hospitals that should have comprehensive emergency obstetric and newborn care (CEmONC) services available 24 hours a day, 7 days a week, many did not have a doctor available to manage obstetric complications as they presented, despite there being an average of seven ob/gyns and four doctors registered for service across all facilities. Slightly over 50% of obstetric emergency cases admitted with postpartum hemorrhage and severe pre-eclampsia/eclampsia did not receive a consultation from an ob/gyn. Among the patients who received consultations, about 70% received consultations by phone or SMS. CONCLUSION: Findings from this study indicate that persistent issues of maldistribution of maternal and newborn specialists and high absence rates of both doctors and ob/gyns at CEmONC hospitals during obstetric emergencies undermines Indonesia's efforts to reduce high maternal mortality rates.