A forgotten priority: maternal health service infrastructure

Weak health service infrastructure contributes to poor maternal health. Apart from inadequate skilled human resources, substandard infrastructure includes poor access to functioning equipment and a lack of essential drugs and supplies.

Scarcity of health workers is perhaps the most fundamentalchallenge to maternity and newborn services worldwide, but increasing thenumber and competency of skilled health professionals is not enough. To beeffective, health workers need access to the right reliable equipment,essential drugs and supplies, and basic and comprehensive care facilities thatare well maintained and effectively distributed.

Well documented problems with maternal health serviceinfrastructure include:

• equipmentavailable is ineffective or inappropriate
• technicalsupport and training is insufficient to operate equipment
• upto a third of equipment is not in service or not formally installed
• ashortage of skilled maintenance personnel and a quick turnover of technicalstaff in the public sector
• alack of tools and spare parts
• inadequatefunds allocated for inputs, maintenance or replacement.

Shortages of essential drugs are also a major constraint todelivering high quality maternal care and have contributed both directly andindirectly to the high number of maternal and newborn deaths and disabilitiesworldwide. In 2002 the World Health Organization estimated that at least one thirdof the world’s population lacks access to essential drugs. In poorer areas ofAsia and Africa this figure may be as high as one half. In addition, the geographicaldistribution and quality of drugs is variable. Also, inappropriate handling,storage and distribution can alter the quality of drugs leading to serioushealth consequences and wasted resources. Users can associate a lack of drugswith a poorer quality of care.

Whilst the poor availability and accessibility of healthfacilities with appropriate services and effective referral systems is wellknown, the poor state of existing facilities is less discussed. Lack ofmaintenance has led to many existing health care facilities being in an advancedstate of disrepair. This requires the rebuilding of new facilities at a greatercost.

The facilities themselves can be further hampered by weak infrastructuralsystems such as water supply and electricity. Uninterrupted supplies of waterand electricity to the operating suite are critical. Even a brief power outageresulting in a rise in temperature of a refrigerator could lead to thebreakdown of a drug and loss of its potency.

The restoration and renovation of facilities should be partof a package of improvements in maternal and newborn care. Upgrading out of useoperating theatres in particular should be a priority. This requires adequateemphasis on the operating cost of health facilities at the time of planningtheir construction.

To ensure the availability of appropriate equipment andsupplies at a reasonable cost, effective procurement systems and staff trainingprogrammes need to be put in place. A strong lead must be taken by ministriesof health.

National lists of essential drugs are needed to improve thequality of care and to save funds on drug costs. In addition a national drugpolicy and supervision undertaken by specially trained pharmacy staff on stockmanagement and adherence to standard treatment guidelines are key components ofany strategy to improve the management and use of drugs.