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Table 3 Characteristics of antenatal care service provision in facility settings in Gaibandha district

From: Antenatal care in rural Bangladesh: current state of costs, content and recommendations for effective service delivery

Type of setting

Facility Level (Primary / secondary healthcare centers)

Family Welfare Centers / Community Clinic

Upazila Health Complex

Maternal and Child Welfare Center

Smiling Sun

Number of the facilities

40-50 clinics

6 clinics (31 beds per clinic)

1 clinic (20 beds per clinic)

4 clinics (2 clinics are emergency obstetric centers and 2 clinics are static clinics with no child delivery service)

Service provision and costs

-Clinical history, Examination, Counseling

-Supplementation and treatment (bacteriuria, TT, iron and folate)

-All services are free

-Clinical history, Examination, Counseling

-Screening/lab test (hemoglobin, proteinuria, urine, blood group, ultrasonogram, syphillis)

-Supplementation and treatment (syphillis, bacteriuria, TT, iron and folate, calcium, balanced energy supplementation, micronutrient, MgSO4, hypertentive disease, diabetes screening, malaria case managmenet)

-$0.036/3 taka for outpatient care; $0.06/5 taka for inpatient care

-Clinical history, Examination, Counseling

-Screening/lab test (hemoglobin, proteinuria, urine, blood group, ultrasonogram, syphillis)

-Supplementation and treatment (syphilis, bacteriuria, TT, iron and folate, calcium, balanced energy supplementation, micronutrient, MgSO4, hypertentive disease, diabetes screening, malaria case managmenet)

-All services are free

-Clinical history, Examination; Counseling

-Screening/lab test (e.g. hemoglobin/proteinuria, $0.36/30 taka; Urine for routine examination, $1.19/100 taka; Blood grouping, $0.24/20 taka; syphilis $1.19/100 taka)

-Supplementation and treatment (TT, iron and folate)

-Different prices per client’s economic status ($0.24/20 taka, $0.12/10 taka, free)

Staffing

Nursing professional /FWV, Paramedics, FWA, Cleaner, Guard

Doctor, Family planning officer, Non-physician, Nursing professional, Paramedics, Pharmacy technologist, MIS manager, Messenger/ driver

General doctor, Non-physician clinician, Anesthetist, Nursing professional, Driver, Cleaner, Guard,

General doctor, Paramedics, Counselor, Lab technician, MIS manager, Community health volunteers, Messenger, Cleaner, Guard

Drugs and supplies

-Maternal care (iron, folic acid, misoprostol, oxytocin, paracetamol)

-Family planning (male condom, oral contraceptive pills, IUDs, implants, injectable, sterilization)

-Maternal care (iron, folic, TT, paracetamol, ORS)

-Family planning (male condom)

-Maternal care (iron, folic acid, TT, sodium chloride, Calcium gluconate, ampicillin powder, hydralazine, azithromycin cap, Cefixime cap, Benzathine benzylpenicillin, Nifedipine, Methyldopa, ORS)

-Family planning (male condom, oral contraceptive pill, IUD, injectable)

-Maternal care (iron, folic acid, TT, sodium chloride injectable, magnesium, ampicillin powder, gentamicin injection, hydralazine, metronidazole injection misoprostol, azithromycin, cefixime, benzathine benzylpenicillin, oxytocin, paracetamol, oral rehydration)

Referral practice

Referral was made from primary care centers/clinics toward secondary and tertiary level hospitals. (FWC→UHC→MCWC). For certain complicated obstetric deliveries (e.g. C-sections), some patients sought care at private clinics that mainly operated on child delivery in this setting. There were limited public ambulances to support patients during labor and child delivery but there were some community based social networks that support vehicles or mobilize funding for poor households.