Availability of health services and preparedness for basic emergency obstetric and newborn care in Togo

Introduction: Togo, like many low-income countries, faces critical challenges in reducing maternal mortality, including limited access to care, inconsistent service quality, and regional disparities in healthcare availability. Improving the accessibility and readiness of health facilities is essential to reduce maternal and neonatal deaths by ensuring timely and adequate care. This study aims to assess the preparedness and availability of services necessary to deliver Basic Emergency Obstetric and Neonatal Care (BEmONC), focusing on the seven essential functions defined by WHO. Using data from the 2021 Harmonized Health Facility Assessment (HHFA) a national cross-sectional survey the study evaluates service availability and readiness across healthcare facilities. Availability was measured based on the presence of the seven BEmONC signal functions, while preparedness was assessed using a composite index that includes three key criteria: trained staff, essential diagnostic equipment, and access to necessary medications. This methodological framework offers a comprehensive evaluation of the capacity of healthcare facilities to manage obstetric and neonatal emergencies in a resource-limited setting, providing critical insights for strengthening maternal and neonatal healthcare systems. Results: An analysis of 200 healthcare facilities in Togo revealed that 76 (38%) of these facilities offer BEmONC services. Hospitals demonstrate superior availability of the seven essential functions and exhibit a higher average preparedness score in comparison to medical-social centres and dispensaries (p<0.05). The study identified that higher preparedness is associated with the geographical location of facilities, the regular undertaking of maternal and neonatal death reviews, and the evaluation of patient feedback. However, disparities persist, particularly in the availability of certain essential interventions, such as manual removal of retained products of conception and neonatal resuscitation. The paucity of ongoing staff training has also been identified as a barrier to the enhancement of services. Conclusion: This study highlights significant disparities in the availability and preparedness of healthcare facilities in Togo to provide BEmONC services. To address this, it is crucial for the Ministry of Health to strengthen quality assurance and implement systematic maternal and neonatal death audits in healthcare centers. An equitable distribution of clinical guidelines, essential medications, equipment, and continuous training is also necessary to improve access to and the quality of BEmONC services. These measures will strengthen facility preparedness and ensure the provision of quality emergency obstetric and neonatal care, especially in resource-limited areas.