Barriers to the delivery of obstetric care within Primary Health Centres
(PHC) in India- a scoping review
Abstract
India faces significant obstetrics related morbidity and mortality. This
burden is largely addressed through the healthcare delivery via Primary
Health Centres (PHCs). This scoping review aims to identify challenges
in delivering obstetrics care within PHCs in India, using the WHO
healthcare building blocks. A literature search covered PubMed, MEDLINE
databases, and Google Scholar. Studies published from 2012 to 2022 were
included based on predefined criteria. Study screenings were conducted
using Covidence. Data extraction of included studies were done by 4
authors. Twenty-two studies were included for final review, mostly
cross-sectional (59%), mainly from the state of Bihar (23%). Service
delivery (77%) and health workforce (73%) were the most extensively
discussed building blocks. Leadership and governance were the least
discussed (14%). Challenges in service delivery encompassed limited
antenatal care uptake, inadequate emergency obstetrics care and adjunct
services, inadequate infrastructure, equipment and space and poor
transport, and onward referral services. Health workforce issues
included staffing levels and competency and training deficiencies in
existing staff. This review highlights challenges in obstetrics care
delivery within PHCs in India, primarily related to service delivery and
health workforce. PHCs play a crucial role in the delivery of obstetrics
services. Developing obstetrics healthcare strategy or policy needs to
acknowledge the role of PHCs and address the challenges faced by PHCs in
order to improve maternal health outcomes.