1.1 Introduction
According to Globalhealthlearning (2021), emergency care provided to treat (and therefore save the life of) a woman experiencing a complication of pregnancy or childbirth. Components of EmOC include the administration of parenteral antibiotics or anticonvulsants, administration of intravenous fluid, using a vacuum extractor or forceps to assist vaginal birth, manual removal of a placenta, removing the products of conception following a miscarriage or abortion, and for comprehensive emergency obstetric care (CEmOC), performing cesarean section surgery to deliver a baby or giving a blood transfusion (Globalhealthlearning, 2021).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitations of the Study and Research Hypothesis and question.
1.2 Background of Study
The days and weeks following childbirth is a critical phase in the lives of mothers and newborn babies, major changes occur during this period which determine the well-being of mothers and newborns. Most maternal and infant deaths occur during this time. The study aimed at assessing and comparing the availability of postnatal care (PNC) services between primary health-care (PHC) facilities in urban and rural settlements in Kaduna State, Nigeria.
Health systems in many low and middle-income countries are characterized by unavailable or nonfunctional emergency medical transport systems. This often means poor access to quality Emergency Obstetric and Newborn Care (EmONC), which is an important determinant of maternal mortality.
Transport challenges exacerbate the second obstetric delay, ie, delay in getting pregnant women who need EmONC services to the health facility, and may lead to deaths from complications arising from causes of maternal deaths, such as hemorrhage, prolonged obstructed labor, sepsis, and eclampsia.
An interplay of economic, sociocultural, geographic, and health system factors contributes to the delays and limits women’s access to prompt EmONC services in times of need.
Barriers to accessing health facilities and trained birth attendants, resulting from transportation difficulties, remain a significant concern.2–4 In many settings where the emergency transport system is managed or provided by the government health system, efforts to transfer women with obstetric complications to health facilities often fail, especially in rural and remote areas, because no vehicles are available, the terrain is difficult, or families cannot afford the associated fees.5–7 This is the case in northern Nigeria, a region characterized by maternal health indictors that are among the poorest in the world. For example, the maternal mortality ratio for Northeast region of Nigeria was recently estimated at 1,549 per 100,000 live births compared with the national figure of 576.
Emergency transport schemes (ETS) interventions, designed to improve pregnant women’s access to EmONC at health facilities, have been undertaken globally in many underserved communities, usually with positive results.9–12 In northern Nigeria, these schemes often involve collaborations between government departments, development partners, and members of the National Union of Road Transport Workers (NURTW). Pilots began in the mid-1990s.13 Since then, various donor-funded projects scaled up ETS interventions in several states in the region. The Partnership for Reviving Routine Immunization in Northern Nigeria; Maternal Newborn and Child Health Initiative (PRRINN-MNCH) reported nearly 20,000 women transported in their project states.14 The Maternal Newborn and Child Health 2 (MNCH2) Programme, a 5-year DFID-funded technical assistance project running from 2014 to 2019, is scaling up these earlier efforts in six states in northern Nigeria. MNCH2 is adding an additional focus – integrating ETS with various demand creation efforts to increase utilization of maternal and child health services. The current study assessed and compared two approaches to ETS. In the first approach, ETS continue to operate as a stand-alone program as implemented by previous projects. In the second, it is integrated with demand creation activities.
1.3 Statement of Problems
Investigation reveals the following problems of the existing research work;
- Insufficient Information about the emergency obstetric care services.
- A lot of people suffer as a result of Ignorance of the effect of improper obstetric care service.
- Inadequate utilization of facilities required for obstetric health care service.
1.4 Purpose of Study
Ensuring adequate access to skilled birth attendants during and after childbirth is a key strategy to reducing maternal and newborn mortalities.
Transportation difficulties in emergency situations continue to be a significant barrier to accessing emergency obstetric care, especially in rural and hard-to-reach areas.
Emergency transport schemes (ETS) have been introduced in various settings to increase access to emergency care and reduce the second obstetric delay with varying degrees of success.
This qualitative study assessed the perceptions of stakeholders and beneficiaries of ETS in two Local Government Areas in Kaduna State, which are;
- Sabon Gari Local Government Area,
- Giwa Local Government Area.
Comparing two models of ETS: one in which the ETS were introduced as a stand-alone intervention, and another in which ETS were part of a package of interventions for increasing demand and improving utilization of maternal and newborn health services.
1.5 Aim and Objectives of Study
The aims and objectives of the study was to determine and compare the availability and distribution of emergency obstetric care services;
- To determine and compare the resource availability for emergency obstetric care services provision;
- To determine and compare the quality of existing basic emergency obstetric care and comprehensive emergency obstetric care services;
- To assess and compare the pattern of utilization of basic emergency obstetric care and comprehensive emergency obstetric care services in both local government areas.
1.6 Research Questions
The following are the research questions of the research work;
- Is there Health workers’ reception of clients attending ANC in PHCs of Sabon Gari LGA, Kaduna State?
- Are clients satisfied with the interpersonal relationship with Health workers in PHCs of Sabon Gari LGA, Kaduna State?
- What are the Opinions of clients on waiting time and time spent with Obstetric health provider during ANC visits at PHCs of Sabon Gari LGA, Kaduna State?
1.7 Research Hypothesis
Hypothesis One
H0: There is no relationship between waiting time and level of satisfaction of clients with services in PHCs of Sabon Gari LGA, Kaduna State.
H1: There is a relationship between waiting time and level of satisfaction of clients with services in PHCs of Sabon Gari LGA, Kaduna State.
Hypothesis Two
H0: There is no Relationship between time spent with provider and level of satisfaction of clients attending ANC in PHCs of Sabon Gari LGA, Kaduna State.
H1: There is a Relationship between time spent with provider and level of satisfaction of clients attending ANC in PHCs of Sabon Gari LGA, Kaduna State.
Hypothesis Three
H0: There is no significant relationship between cleanliness of the health facilities and level of satisfaction with ANC services at PHCs of Sabon Gari LGA, Kaduna State.
H1: There is no significant relationship between cleanliness of the health facilities and level of satisfaction with ANC services at PHCs of Sabon Gari L.G.A., Kaduna State.
1.8 Scope of Study
The study focuses on the Availability, Accessibility and Utilization of Emergency Obstetric Care Services using Sabon Gari Local Government Area, and Giwa Local Government Area in Kaduna State, Nigeria as a case study.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this project work. There were lots of information needed from the staffs of this institution to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
1.10 Significance of Study
This research work will be beneficial to obstetric health care provider, by providing relevant information about the effects and benefits of emergency obstetric care service.
Besides, the study will serve as reference material for subsequent researcher in the field or related topics.
