Assessing the delivery of comprehensive emergency obstetric services in South India: Findings from a mid-term evaluation

Background: The Tamil Nadu Health Systems Project (TNHSP) is a key state wide program initiated in 2005 to reduce the high rates of maternal mortality and morbidity through establishment of Comprehensive emergency obstetric and neonatal service (CEmON) centers offering round the clock facility services and community mobilization addressing social determinants of maternal mortality.

Methods: Facility based service statistics and routine reporting data from 47 CEmON centers under the TNHSP project for the period March 2007 - March 2008 was used for this evaluation. Descriptive analyses included means, prevalence and rates, and statistical analyses including linear regression models and Spearman rank correlation coefficient were computed to understand current service utilization patterns, evaluate service delivery to identify areas for improvement and effect mid-course corrections.

Results: High rates for episiotomies (58% Vs. 30%) and caesarean sections (25.3% vs. 13%) with a low rate of assisted vaginal deliveries (2% Vs. 6%) in comparison to national averages for similar facilities and a strong association between the incidence of complicated maternal admissions and rates of caesarean deliveries (Spearman coefficient (ó) 0.834. p <0.00001) were identified. Maternal deaths due to bleeding complications at 50% were twice the national estimates, and unadjusted linear regression model indicated a negative relationship between the use of blood banking services and maternal deaths (co-efficient -4.44, p <0.05).

Conclusions: Study results indicate the need for implementation of evidence based decision making in managing labor, a caesarean audit program and improvements to blood banking services to improve quality of services at CEmON centers.