Factors influencing the performance of delivery centers in urban slums of Bangladesh: a qualitative study.

Abstract

Averting the devastating majority of maternal mortality, BRAC initiated an intervention named Manoshi in 2007; maternal, neonatal and child health program for the urban poor of Dhaka city. It established delivery centers (DC) to provide clean and safe delivery services by community health workers (CHW) as well as referring maternal and neonatal complications to equipped hospital. The study aimed to measure the performance of DCs and explore the factors related to its performance. Data was collected using qualitative methods during December 2009 -January 2010 from six DCs in the slums of Dhaka city. Findings revealed that the DCs at Magbazar and Kamrangir Char performed ‘well’ due to availability of CHWs, their emotional support and caring attitude, regular antenatal care (ANC) visits, convenient location, cleanliness and free services of the DCs. The DCs at Madertek and Shyampur performed ‘average’ and Ramna and Kotwali DCs performed poor. Poor performance was largely due to lack of CHWs, less motivation, frequent dropout due to low remuneration, and recurrent slum demolition. The reasons for women not attending DCs were fear of being referred to the hospital which might compel them to have a caesarean delivery, lack of comprehensive services at DCs including doctor-assisted normal deliveries, medicines, and emergency case management. Neonatal mortality rate in poor performed DCs found to be high. The respondents recommended that instead of referring women for minor complications, DCs should be competent of providing supervised skilled service package with basic treatment during childbirth, tetanus toxoid during ANC and child immunizations during postnatal care. Given the existing scenario, the program needs to pay attention to the ‘poor’ performed DCs with developing alternative strategies to enhance collaboration with existing health facilities and emphasizing community mobilization on ANC, safe delivery and strengthen appropriate referral for obstetric and neonatal complications.