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Access to healthcare | Endemic/Epidemic disease

This year Katiola hospital’s maternity unit started providing care for complicated deliveries and ante- and neonatal emergencies.
Mother and pre- and antenatal care is a priority for the Ministry of Health in Côte d’Ivoire, as maternal mortality has been increasing since 2005. Women generally deliver their babies at home with traditional birth attendants and without effective emergency obstetric care when there are complications.

With the Ministry of Health, Doctors Without Borders (MSF) opened a mother and child health programme in Katiola hospital in 2014. The 90-bed facility serves as the sole referral hospital for the whole region but until recently had very limited capacity to provide emergency obstetric and neonatal care.

Only women who could afford to be transported by ambulance were referred to the larger Bouaké hospital to get the necessary medical assistance. MSF renovated Katiola’s maternity unit and the two operating theatres, built a water supply and sewage network in the hospital, and organised training for midwives.

As a result, emergency obstetric care and complicated deliveries are now being managed by MSF, and between July and December over 1,000 births, more than 100 of them requiring caesarean sections, were assisted.

Due to the increase in maternal mortality rates,[i] Doctors Without Borders (MSF) works with the Ministry of Health in Côte d’Ivoire to improve maternal and child health.In Hambol region, around 50 per cent of women give birth at home, and a study undertaken by Epicentre in March 2015 found significant levels of maternal mortality.[ii]

Katiola is the main town in Hambol region and MSF runs a programme in the Centre Hospitalier Régional (CHR) there in partnership with the Ministry of Health. MSF provides resources and technical support, enabling the CHR to operate a high-quality emergency obstetric and neonatal care unit for complicated cases. MSF manages the 20-bed maternity department, three intensive-care beds, two operating theatres and 10 neonatal beds.

In 2015, the facility served as a referral hospital for 98,000 women of child-bearing age, 14,800 pregnant women and 14,000 newborns. Staff managed 755 obstetric emergencies, high-risk pregnancies and complicated births, dealt with 600 gynaecological emergencies and assisted 2,600 births, 374 of which required caesarean sections.

Since May, MSF has been supporting and improving (through the renovation of buildings, medical equipment and staff training) the basic emergency obstetric and neonatal care units in outlying areas, to ensure that good-quality medical care is more easily accessible for mothers and children.

In addition, MSF has been working to improve the management of straightforward deliveries and referrals to Katiola. In the second half of the year, staff in two outlying health centres treated 106 women during obstetric emergencies, high-risk pregnancies or complicated births, as well as 28 gynaecological emergencies. They assisted over 400 births, and referred around 50 patients to the maternity unit at Katiola.

Ebola in neighbouring countries
As a consequence of the Ebola outbreak, the borders with Liberia and Guinea were closed in August. No suspected cases were reported in 2014, but an MSF team visited the area bordering Liberia to assess the preparedness of local staff and the authorities, as well as community awareness.

MSF collaborated with the health authorities to build an Ebola management centre in Yopougon hospital in Abidjan (the country’s largest city), as a contingency plan. MSF also supported the training of health staff and rapid investigation teams.

[i] From 543/100,000 live births in 2005 to 614/100,000 in 2012 (Enquête Démographie et de Santé et à Indicateurs Multiples de 2011–2012 (EDSCI-III))

[ii] 660/100 000 (Epicentre)

No. staff in 2014: 152 | Expenditure: €2.3 million | Year MSF first worked in the country: 1990