Opportunities and Constraints Affecting Service Delivery of Basic Emergency Obstetrics and Neonatal Care (BEmONC) in Resource Constrained Environment: West Pokot Kenya

Background: Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Most maternal and neonatal deaths in low-income countries, including Kenya, are attributable to a handful of preventable causes. Emergency obstetric and newborn care (EmONC) is an integrated strategy that aims to equip health workers with skills, life-saving medicines, and equipment to manage the leading causes of maternal and newborn death. It is on this basis that this study was conducted to find out how the BEmONC training impacted on the reproductive health services that the people of West Pokot are receiving despite the several challenges the county is facing to include a high burden of maternal and newborn mortality. Objectives: The specific objective was to establish challenges and opportunities affecting service delivery of BEmONC services, following the training program that was rolled out in the year 2014, in West Pokot County, Kenya. Methods: A methodological triangulation design was used as it incorporated elements of both quantitative and qualitative approaches. Informing this decision was the Pragmatic worldview. Quantitative approach adopted a descriptive cross sectional ex post facto design of 49 randomly selected health facilities. The BEmONC observation checklist, guided and in- depth interviews were used to collect qualitative data. The sample size was purposively determined when saturation of the data was reached and data was analyzed thematically. Results: Findings indicated that the Basic Emergency Obstetrics and Neonatal training program was effective but the level of its effectiveness varied by facility type, designation, geographical setting and operating agency. The challenges that affected BEmONC service delivery included understaffing (92.6%), lack of supplies and equipment (63%), poor infrastructure (44.4%), ineffective transport and communication (69%), insecurity (42.9%