Creating Demand for and Quality of Emergency Obstetric Care in a Fragile State Context: The case of Kuajok hospital in South Sudan

By Alfonso Rosales, MD, MPH-TM, World Vision, MNCH senior advisor and Juli Hedrick, MPH, World Vision Health Team, senior program management specialist.

Training.Models

MTI volunteer Brenda, RN, sets up anatomical models for staff at Kuajok Hospital to practice emergency obstetric care.

Early Easter morning, Paska and Esther, twin girls, were born in Kuajok, the capital of Warrap State, South Sudan. Their country is a perfect storm for poor maternal health, with one of the lowest number of midwives per population and the highest maternal mortality ratio—service coverage and quality remain elusive to most women.

But Paska and Esther were born with no problems, both weighing around 9 pounds! Their mother knew to seek prenatal care and give birth in a health facility (Kuajok Hospital) in case complications arose. Warrap State is where World Vision, contracted by donor agency South Sudan Health Pooled Fund, is supporting the Ministry of Health to implement a health system strengthening intervention aimed to improve Comprehensive Emergency Obstetric and Newborn Care (CEmONC) services by improving staff capacity, access to adequate equipment, required infrastructure, and more.

According to a recent study by WHO on maternal and newborn health, it is necessary to go beyond maximizing coverage of essential interventions to accelerate reductions in maternal mortality. The study demonstrated that despite high coverage, many women still die due to hemorrhage and other disorders of pregnancy. This highlights the need for improved quality of maternal health care and a comprehensive approach to emergency care.

The challenges are many: Kuajok, far from South Sudan’s capital of Juba, is considered a hardship posting, making staff recruitment and retention difficult. Basic supplies must be trucked in from a distance; insufficient beds yield mattresses on the floor; storage space is limited; there is no centralized records database; water is precious and the land unbearably hot and endlessly dusty – at least until rainy season, when mud creates an additional level of challenge.

MTI

However, in a recent visit to the region, great strides in progress were undeniable. In recent weeks, a group of 18 staff attended a World Vision-sponsored multi-week CEmONC course led by a volunteer from Medical Teams International (see sidebar) in coordination with the hospital’s Senior Medical Officer and Senior Midwifery Officer. In addition to classroom-style teaching, attendees were able to practice with anatomical models and share experiences.

By the end of the third quarter of project implementation, CEmONC services are functional, meaning that all nine clinical functions to service obstetric and newborn complications are in place. In addition, an incinerator, vital for biohazard control, is nearly finished. Solar-powered lights are now installed in the maternity ward and sturdy examination tables have been delivered. A new ambulance serves the hospital’s referral area, and two shipping containers of supplies are soon to be delivered.

And demand for services is high—it has surpassed the proportion of all births in the CEmONC facility by 12 percent. This illustrates that rapid deployment of emergency obstetric care by INGO-supported public services in a fragile state context is feasible if the quality of emergency obstetric services are closely monitored.

The stronger South Sudan’s health system becomes, including remote areas like Kuajok, the more healthy babies like Paska and Esther will be born safely.