Background
Methods
Study setting
Health facility type | Number of health facilities | Average number of health workersb | Average number of bedsc | Average catchment population [32] |
---|---|---|---|---|
Primary healthcare (levels 1-4) | ||||
Community health posts | 3088d | 3 (2) | 1.9 | 500-2000 |
Sub-health centers and urban clinics | 458d | 6.4 (4) | 5.4 | 2000-5000 (rural population) >10 000 (urban population) |
Health centers | 261d | 11 (7) | 16.5 | 5000 -10 000 |
District/rural hospitals | 14 | 39.5 (14-35) | 61.3 | >70 000 |
Secondary healthcare (levels 5-7) | ||||
Provincial/ / national referral hospitals | 21e | 176 (63-355) | 78.8 | 1000- total population |
Data sources
Defining key variables
Health facility readiness is measured by the factors related to a health facility’s capacity to provide healthcare [22, 30]. This study specifically measures the readiness to provide routine ANC services. Adopting the approach used by Leslie et al. (2017) [40], we created a health facility readiness score for each facility that comprised four domains: amenities; protocols for infection prevention; diagnostic equipment; and medicines and medical supplies Each domain includes multiple indicators (see Table 2). The choice of indicators for each domain was guided by the SARA toolkit [30] and adapted to the PNG context [16]. A full description of how the scores were compiled is presented below under ‘statistical analysis’.
Domain / Indicators | Explanation of indicator |
---|---|
Basic amenities | |
Electricity | Electricity is available |
Back-up generator | Back-up power source (generator) available |
Fuel for generator | Health facility has fuel to run the generator |
Running water | Running water is available and piped into the health facility |
Toilet | At least one functional toilet (can be pit without slab, pit with slab or flushable) available for patients |
Communication equipment | A functional telephone (landline), shortwave radio or mobile phone is available for communication purposes |
Emergency transport | A vehicle, not necessarily an ambulance, is available and has the primary function of transporting patients |
Protocols for infection prevention | |
Sharps final disposal | Protocol in place for final disposal of sharps (e.g., taken of offsite, burnt and/or buried) |
Final bio-waste disposal | Protocol in place for final disposal of bio-waste (e.g., taken offsite, burnt and/or buried) |
Waste segregation | Segregates sharps, general- and bio-waste into different bins |
Diagnostic equipment | |
EDD calculator | Expected date of delivery (EDD) calculator available and able to estimate EDD and gestational age |
Scale | Available to measure the weight of antenatal clinic attendees |
Tape measure | Available to measure fundal height (size of uterus) and able to estimate gestational age |
Foetal stethoscope | Pinard horn is available to check the baby’s heart rate |
Blood pressure machine | Sphygmomanometer is available to measure blood pressure |
Refrigerator/Vaccine carrier | Suitable vaccine carrier available to store/administer vaccines safely |
Urinalysis dipsticks and collection cups | In-stock and available to test urine for protein and glucose to help diagnose pre-eclampsia and gestational diabetes |
Point-of-care HIV test-kits | Serological HIV point-of-care test-kits to test for HIV are available and in-stock (including 30 days prior to survey) |
Point-of-care syphilis test-kits | Serological syphilis point-of-care test-kits to test for syphilis are available and in-stock (including 30 days prior to survey) |
Medicines and medical supplies | |
Gloves | Examination gloves are available and in-stock (including 30 days prior to survey) |
Needles and syringes | Needles and syringes are available and in-stock (including 30 days prior to survey) |
Cotton wool | Cotton wool is available and in-stock (including 30 days prior to survey) |
Water for injection | Water for injection, used to reconstitute substances, is available and in-stock (including 30 days prior to survey) |
Iron and folate supplement | Iron and Folate oral supplement, used to treat anaemia, is available and in-stock (including 30 days prior to survey) |
Sulfadoxine/pyrimethamine (SP) | SP, used for intermittent prevention of malaria in pregnancy, is available and in-stock (including 30 days prior to survey) |
Tetanus toxoid | Tetanus toxoid, used to prevent neonatal tetanus, is available and in-stock (including 30 days prior to survey) |
Benzathine-penicillin | Benzathine-Penicillin, used to treat syphilis, is available and in-stock (including 30 days prior to survey) |
Antiretroviral therapy (ART) | ART, first line therapy used to treat HIV, is available and in-stock (including 30 days prior to survey). ART comprises of tenofovir or zidovudine plus lamivudine and efavirenz or nevirapine |
Statistical analysis
Results
Variable | Health facilities n (%) |
---|---|
Region | |
Highlands | 21 (28.8) |
Momase | 17 (23.3) |
New Guinea Islands | 17 (23.3) |
Southern | 18 (24.7) |
Health facility type | |
Hospital | 19 (26) |
District/ Rural Hospital | 7 (9.6) |
Health Centre | 47 (64.4) |
Location | |
Urban | 19 (26) |
Rural | 54 (74) |
Managing authority | |
Public | 47 (64.4) |
Church | 26 (35.6) |
Population, and service statistics | Average (range) |
Pregnant women in catchment population (n) | |
Urban | 1560 (116- 14 408) |
Rural | 627 (36- 2273) |
Pregnant women making at least one antenatal clinic visit (n) | |
Urban | 1043 (64- 3206) |
Rural | 295 (29- 857) |
Antenatal clinic attendants tested for HIV at sampled health facilities (%) | |
Urban | 5.6 (0- 38.9) |
Rural | 23.5 (0- 100) |
HIV seropositive antenatal clinic attendants treated at sampled health facilities (%) | |
Urban | 4.2 (0- 50) |
Rural | 1.1 (0- 40) |
Antenatal clinic attendants tested for syphilis at sampled health facilities (%) | |
Urban | 11.1 (0- 81.7) |
Rural | 4.3 (0- 28.4) |
Syphilis seropositive antenatal clinic attendants treated at sampled health facilities (%) | |
Urban | No data |
Rural | No data |
Service availability
Health facility readiness
Regression analysis
Proportion of antenatal clinic attendees tested for HIVa | |||
---|---|---|---|
Coefficient [95% CI] | t | P> |t| | |
Supply-side readiness score | 12.78 [0- 59.67] | 0.54 | 0.589 |
Proportion of HIV seropositive antenatal clinic attendees treatedb | |||
Coefficient [95% CI] | t | P> |t| | |
Supply-side readiness score | 10.25 [0 – 21.95] | 1.75 | 0.085 |
Proportion of antenatal clinic attendees tested for Syphilisc | |||
Coefficient [95% CI] | t | P> |t| | |
Supply-side readiness score | 22.7140 [0 – 46.14] | 1.93 | 0.057 |
Variable | Tested for HIVa | HIV seropositives treatedb | Tested for Syphilisc | ||||||
---|---|---|---|---|---|---|---|---|---|
Coefficient [95% CI] | t | P> |t| | Coefficient [95% CI] | t | P> |t| | Coefficient [95% CI] | t | P> |t| | |
Readiness score | 29.59 [0 – 87.06] | 1.03 | 0.307 | -3.12 [0 – 16.62] | -0.32 | 0.753 | -0.26 [0 – 16.94] | -0.03 | 0.976 |
Health facility type | |||||||||
Hospital | Reference Category | ||||||||
District/rural hospital | 35.05 [0 – 75.73] | 1.72 | 0.090 | -0.67 [0 – 9.00] | -0.14 | 0.890 | 2.17 [0 – 15.67] | 0.32 | 0.749 |
Health centre | 24.38 [1.75 – 47.02] | 2.15 | 0.035 | 1.07 [0 – 10.43] | 0.23 | 0.820 | -5.42 [0 – 10.03] | -0.70 | 0.486 |
Public/ Church run | |||||||||
Church | Reference Category | ||||||||
Public | 8.83 [0 – 23.30] | 1.22 | 0.227 | 3.07 [0 – 8.10] | 1.22 | 0.228 | 0.62 [-0– 5.09] | 0.28 | 0.783 |
Size of catchment | |||||||||
>10 000 | Reference Category | ||||||||
10 000 – 19 999 | 8.85 [0 – 24.41] | 0.55 | 0.260 | 5.67 [0 – 11.75] | 1.86 | 0.067 | 7.14 [0 – 14.28] | 2.00 | 0.050 |
20 000 – 29 999 | 22.17 [8.51 – 35.84] | 2.71 | 0.002 | -0.62 [0 – 5.21] | -0.21 | 0.833 | 8.07 [0 – 17.34] | 1.74 | 0.087 |
30 000 – 49 999 | 2.53 [0 – 19.24] | 1.00 | 0.763 | -0.52 [0 – 6.56] | -0.15 | 0.883 | -4.71 [0 – 2.46] | -1.31 | 0.194 |
< 50 000 | 22.23 [0 – 46.50] | 2.04 | 0.072 | 1.51 [0 – 8.74] | 0.42 | 0.678 | -6.86 [0 – 1.80] | -1.58 | 0.118 |
Clinicians employed | 1.14 [0 – 9.95] | 0.30 | 0.768 | 2.13 [0 – 5.42] | 1.29 | 0.202 | 2.11 [0 – 5.63] | 1.20 | 0.236 |