Health Workforce related challenges for Emergency Obstetric Care at peripheral health facilities: Providers’ Perspective

Abstract Introduction: Ministry of Health and Family Welfare of India is constantly Functioning to provide optimum health care to achieve Sustainable Development Goals (SDGs) by updating health infrastructure. Objective:  To study the readiness and challenges of peripheral health facilities regarding skilled health workforce to provide Emergency Obstetric Care (EmOC). Materials and Methods: A descriptive phenomenological type of qualitative research study was done in all peripheral health facilities (seven) in Deoli block of Wardha District (Maharashtra, India) from February-July 2014. Key informant interviews of Emergency Obstetric Care (EmOC) service providers at different level (facility, block and district level) were conducted by using stratified purposive sampling,  to obtain their perspective regarding facility preparedness for health workforce in terms of their availability and skilfulness (training) and barriers if any to provide EmOC. Written informed consent of participants to conduct and audio recording of interview session was obtained. Thematic analysis of data was done where in appropriate, significant and evocative remarks from service providers were used for analysis. Themes that were emerged out after discussion with all providers (participants) were presented. Comments were presented in text form with quotes to highlight the study findings whenever appropriate. Results: Service providers shared key concern about medical officers who have recently completed graduation and recruited for one-year bonded service but mostly desire for further education and show minimal involvement in service. Trained contractual Medical Officers left over service after completion of bond. Usually single Medical Officer remains available in most of the Primary Health Center (PHCs). Stakeholders discussed the difficulties about retention of specialist in rural hospital. Insufficient trainers and training pattern are significant challenges; suggested to shift from theoretical to practical skill and trainees’ selection for improving outcome. Conclusion: Contractual staff is the current option to address health workforce issue. After building up capacity of such staff, their consistent availability is challenging for district stakeholders too. Training for EmOC was provided at the district level, but to develop practical skill among trainees more hands on practice was essential. This requires significant policy level interventions.