Functional Readiness of Health Facilities to Deliver Emergency Obstetric and Newborn Care in Adamawa, Kwara and Sokoto States of Nigeria: A Cross-Sectional Study of 913 Public Facilities
A cross-sectional study of 913 public health facilities in Adamawa, Kwara, and Sokoto states reveals that most lack functional readiness to deliver Emergency Obstetric and Newborn Care, with essential medicine availability identified as a critical independent predictor of readiness.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In many parts of the world, the difference between a safe birth and a tragedy often comes down to whether a health clinic has the right tools and medicines at the exact moment they are needed. This reality is the focus of emergency obstetric and newborn care, a set of life-saving skills and supplies designed to handle the most dangerous complications of pregnancy and childbirth. These complications can strike without warning, turning a routine delivery into a crisis within minutes. To survive, a mother or her baby might need a specific antibiotic to stop an infection, a drug to stop heavy bleeding, or a skilled hand to perform a surgical delivery. Health systems around the globe try to ensure that facilities are ready to provide these services, but having a building labeled as a hospital or a clinic does not guarantee that the necessary skills and supplies are actually present and working when a crisis hits.
A recent study set out to look past the labels and check the actual readiness of health facilities in three Nigerian states: Adamawa, Kwara, and Sokoto. Researchers visited nearly one thousand public health centers that had recently delivered babies to see if they could truly handle an emergency. They focused on two levels of care. The first level, known as basic emergency care, involves seven key actions like giving injections for infection or manually removing a placenta. The second, more advanced level includes those seven actions plus two major surgical capabilities: performing a cesarean section and giving a blood transfusion. The team wanted to know not just if these places existed, but if they were functionally prepared to save lives when the time came.
The investigation revealed a stark gap between what these facilities were supposed to do and what they could actually do. Out of the 840 facilities designated to provide basic emergency care, only a tiny fraction were fully ready to handle every possible complication. In fact, more than sixty percent of these basic facilities were not ready at all, meaning they lacked the ability to perform even half of the required life-saving tasks. Only about three percent of them could do everything needed. The situation was slightly better, though still far from perfect, at the higher-level facilities meant to provide comprehensive care. Even there, fewer than one in three facilities could perform all nine of the advanced functions required for a full emergency response.
The study also looked at what was happening inside these buildings. While many clinics had the basic equipment and some medicines, critical gaps remained. For instance, while most places had antibiotics and fluids, a vital drug used to stop severe bleeding after birth was missing from the shelves in the vast majority of facilities. The researchers found that when a facility had a better supply of these essential medicines, it was much more likely to be functionally ready to perform the necessary medical tasks. However, having the medicines alone was not enough. Many places had the drugs sitting on a shelf but still could not perform the life-saving procedures, suggesting that the staff lacked the training, the equipment, or the confidence to use them effectively.
The findings highlighted deep inequalities across the three states. Facilities in one state, Kwara, were significantly less prepared than those in the others, even after accounting for differences in the types of buildings or the availability of medicines. This suggests that the problem is not just about having supplies, but about the broader health system, including how staff are trained and how resources are distributed. The researchers noted that the most difficult tasks, such as performing a cesarean section or a blood transfusion, were rarely done, even in facilities that claimed to offer them. This points to a need for more than just better planning; it requires a coordinated effort to build skills, ensure a steady flow of medicines, and strengthen the infrastructure that supports these critical services.
Ultimately, the study serves as a clear warning that naming a facility a place for emergency care does not make it one. The reality on the ground shows that most of these centers are not yet capable of handling the full range of emergencies that mothers and newborns face. The path forward requires moving beyond simple labels and focusing on what is actually happening inside the clinics. By ensuring that medicines are available, that staff are skilled, and that the systems are strong enough to support them, health leaders can begin to close the gap between the promise of care and the reality of survival.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.