Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data

PLOS ONE RESEARCH ARTICLE Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of crosssectional survey data Pramila Rai ID, Ilana N. Ackerman ID☯, Denise A. O’Connor☯, Alexandra Gorelik ID, Rachelle Buchbinder ID*☯ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Rai P, Ackerman IN, O’Connor DA, Gorelik A, Buchbinder R (2023) Health facility availability and readiness for family planning and maternity and neonatal care services in Nepal: Analysis of cross-sectional survey data. PLoS ONE 18(8): e0289443. https://doi.org/10.1371/journal. pone.0289443 Editor: Kanchan Thapa, Province Health Service Directorate Surkeht, Technical Support Unit (TSU), NEPAL Received: May 2, 2023 Accepted: July 19, 2023 Published: August 7, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0289443 Copyright: © 2023 Rai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The data used in this study are owned by the Demographic and Health Objectives To determine the availability and readiness of health facilities to provide family planning, antenatal care and basic emergency obstetric and newborn care in Nepal in 2021. Secondary objectives were to identify progress since 2015 and factors associated with readiness. Method This is a secondary analysis of cross-sectional Nepal Health Facility Survey (NHFS) data collected in 2015 and 2021. The main outcome measures were availability and readiness of family planning, antenatal care, and basic emergency obstetric and newborn care services. Readiness indices were calculated using WHO-recommended service availability and readiness assessment (SARA) methods (score range 0 to 100%, with 100% indicating facilities are fully prepared to provide a specific service). We used independent t-tests to compare readiness indices in 2015 and 2021. Factors potentially associated with readiness (rurality setting, ecological region, managing authority, management meeting, quality assurance activities, and external supervision) were explored using multivariable linear regression. Results There were 940 and 1565 eligible health facilities in the 2015 and 2021 surveys, respectively. Nearly all health facilities provided family planning (2015: n = 919 (97.8%); 2021: n = 1530 (97.8%)) and antenatal care services (2015: n = 920 (97.8%); 2021: n = 1538 (98.3%)) in both years, but only half provided delivery services (2015: n = 457 (48.6%); 2021: n = 804 (51.4%)). There were suboptimal improvements in readiness indices over time: (2015–21: family planning 68.0% to 70.9%, p<0.001, antenatal care 49.5% to 54.1%, p<0.001 and basic emergency obstetric and newborn care 56.7% to 58.0%, p = 0.115). The regression model comprising combined datasets of both NHFSs indicates facilities with regular management meetings and/or quality assurance activities had significantly greater readiness for PLOS ONE | https://doi.org/10.1371/journal.pone.0289443 August 7, 2023 1 / 18 PLOS ONE Health facility availability and readiness for family planning and maternity and neonatal services in Nepal Surveys (DHS) Program and re-distribution of DHS data is not permitted by the DHS program. These data are available upon request and approval from the DHS Program. Data requests can be made through the link: https://dhsprogram.com/data/ new-user-registration.cfm. all three indices. Similarly, public facilities had greater readiness for family planning and basic emergency obstetric and newborn care while they had lower readiness for antenatal care. Funding: The authors received no specific funding for this work. Ms Rai is supported by a Monash University International Postgraduate Research Scholarship and Graduate Scholarship for her doctoral research. Dr Buchbinder is supported by an Australian NHMRC Investigator Fellowship (APP1194483). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Readiness to deliver family planning, antenatal care and basic emergency obstetric and newborn care services in Nepal remains inadequate, with little improvement observed over six years. Competing interests: The authors have declared that no competing interests exist. Conclusions Introduction About 15% of expected births worldwide result in life-threatening complications during the childbirth or the postpartum period [1]. Sometimes these complications develop rapidly and without warning, requiring immediate care [2–5]. According to the latest available data, maternal complications such as postpartum haemorrhage, puerperal sepsis, pre-eclampsia, eclampsia, obstructed or prolonged labour, and complications associated with unsafe abortion account for nearly 75% of maternal deaths globally [6, 7]. These issues are particularly relevant for lower and lower-middle income countries, such as Nepal, as 94% of the maternal deaths occur in these regions [8]. The highly acclaimed safe motherhood program [9, 10], which includes family planning, antenatal care, basic and comprehensive emergency maternity care, and postpartum care is not new to the Nepali health care system [11–13]. The safe motherhood program has been a central component of healthcare delivery in Nepal since the 1990s, contributing to significant improvements in maternal and neonatal health status over the last three decades [14]. In 2008, family planning alone was estimated to prevent 53% of maternal deaths in Nepal [15–17]. However, current health indicators such as the maternal mortality rate (239/1,000,000 live births), neonatal mortality rate (21/1,000 live births), and low contraceptive use (43% of reproductive aged women or their partners), indicate that improvements in existing health programs and their delivery are still needed [18, 19]. The persistent burden of maternal and neonatal mortality in Nepal (despite an increasing proportion of institutional births and antenatal care in recent years), also questions the quality of the services provided [20, 21]. Over 50% of maternal deaths in Nepal occur in health facilities or during the transition to health facilities, highlighting the need for service improvement [22]. Provision of high quality care for all women and newborn babies could prevent up to 54% of maternal deaths and (...truncated)