Mapping the quality of basic and comprehensive emergency obstetric care services in Haiti.

Objective: To investigate geographical inequalities and changes in the quality of emergency obstetric care services available in Haiti over time. Methods: We utilised data from the Service Provision Assessment (SPA) survey of all health facilities in Haiti in 2013 and 2017.We developed a quality index for Basic and Comprehensive Emergency Obstetric Care (BEmOC and CEmOC) based on the items in the signal functions of emergency obstetric care framework, using a structure, process and outcome framework. We measured the quality index of all facilities in 2013 and 2017. We also assessed geographical trends and changes in quality between 2013 and 2017 using geospatial analysis. Result: Our analysis showed that basic structure items such as connection to electricity grid, manual vacuum extractors, vacuum aspirators and dilation and curettage kits were widely unavailable at health care facilities. There was a significant improvement in indicators of structure (p < 0.001) and BEmOC (p = 0.03) in primary facilities, however there was no significant change in quality of CEmOC in primary facilities (p =0.18). Similarly, there was no significant change in any of the structure or process indicators at secondary care facilities: structure items Conclusion: The availability of basic emergency obstetric care at several Haitian facilities remains poor, however there was significant improvement at primary care facilities, with little to no change in overall quality at secondary health facilities.