Assessing Quality of Facility-Based Normal Delivery Care in Nepal: Readiness, Functionality, Standards of Care, and Women’s Satisfaction
Abstract:
Background: Maternal mortality remains disproportionately high in low- and middle-income countries, accounting for 95% of global maternal deaths. In Nepal, the maternal mortality ratio remains high at 151 per 100,000 live births (2021). Expanding facility-based deliveries and enhancing the quality of care are crucial to accelerating progress. This study examines changes in facility readiness and functionality of emergency obstetric and newborn care (EmONC) services from 2015 to 2021, adherence to delivery care standards, and factors influencing women’s satisfaction with delivery services in 2021.
Methods: Data from the Nepal Health Facility Surveys (2015 and 2021) were analyzed. Facility readiness included 457 facilities in 2015 and 804 in 2021. Functionality of EmONC included assessment of 26 and 43 basic EmONC and 21 and 52 comprehensive EmONC facilities in 2015 and 2021, respectively. Standards of care and satisfaction analyses used data from 320 women. T-tests and logistic regression statistical analysis were used.
Results: Facility readiness for normal deliveries improved modestly, from 37.9% to 43.7%, with variations across different domains. Comprehensive EmONC facilities were more functional than basic EmONC facilities. Compli ance with care standards ranged from 52.4% for human resource competency to 92.0% for functional referral. Women’s satisfaction was positively associated with caring behavior, privacy, and visible health statistics.
Conclusions: Despite progress in facility-based deliveries, persistent quality gaps hinder maternal mortality reduc tion. Strengthening quality of care, provider competency, and accountability across Nepal’s federal health system is essential for maternal mortality reductions.
