Bottleneck AnalysisBEmOC and CEmOC

Group -2Nepal, Bangladesh, Pakistan,

Afghanistan , Sri Lanka, Indonesia

BEmONC

Priority BottlenecksSupply side

• Policy and Strategic Plan and Poor Governance

• Inappropriate allocation of Fund

• Insufficient HR/ Skilled Person/Distribution /Retention/Accredit

Possible Solutions

• Policy Document need to be updated and scaled up

• Proper allocation of fund and planning for MNCH services

• Ensure 24/7 , task shifting• Production of SBA ( Mid wives)

/strengthening• Performance based

Incentive /enabling environment to address those issues

BEmONC

Bottle Neck– Monitoring and Supervision

– MIS

– No structural or Poor Referral Mechanism

Possible Solution• Strengthening of E-

monitoring and supervision• Strengthening of MIS with

analysis and action• Strengthening Accountability of

all service providers• Referral Guidelines must be

implemented and provision of Vehicle /PPP (Referral HUB)

• Coordination between service delivery levels (mobile phone, Maternity waiting home etc)

BEmONC

Bottle NeckDemand side:• Lack of knowledge and

decision power to use the BEmONC facilities.

• Lack of Accessibility , acceptability and affordability of BEmONC facilities

• In Equity – Geographical

(Urban rural, poor-rich)– Economic – Cultural

Possible Solution

Women empowerment through education /BCC through communication (C4D)

• Equitable availability of quality B & CmONC of care in the facility/PPP

• Equity focused , evidence based LLP

• Equitable resources allocation

CEmONC

Additional BottleneckSupply Side• Infrastructure

– Diagnostic – OT (Operation Theater)– HR– Maintenance– Blood Transfusion

Possible Solutions

• Need based planning • Ensure trained manpower in

place • Readiness of the facility

according to the checklist• Ensure diagnostic and blood

transfusion facility• Demand side Financing and

PPP

Unique Problem

Bottleneck• Pakistan

– Natural Disaster – Geographical and sociocultural and

Female Education

• Nepal– Cultural – Geographical

• Afghanistan– Financial Allocation– Security – Geographical

• Indonesia– Decentralization No policy to support sustainability of BEmOC and CEmOC

Possible Solutions• Readiness for Emergency

preparedness and response plan for Mother and Child

• Culture appropriate need based plan

• Establish policy for the functioning all public and private hospital to provide EmOC