Health system and cultural challenges when implementing Moyo FHRM in four DHs in Bihar
| Existing practices | Insufficient human resources | Action delays | Other cultural and local challenges |
| DHs are not following national guidelines.6 No systematic FHRM during labour. CS not done due to fetal reasons. Partogram not used (documentation). Instrumental deliveries not common. | High workload. Unable to adequately monitor each woman in labour. Only one doctor on call with multiple tasks. | Need to wait for gynaecologist or anaesthesiologist. Concurrency conflict. Challenges with the other teams (laboratory staff, operation team). Delay in obtaining consent to operate from the relatives. Lack of needed laboratory tests. | High turnover among the doctors leads to constant need for skill training. Hospital hierarchy. Patient’s and relative’s attitude towards female babies.* Possibility to buy oxytocin without prescription. Oxytocin use without ordination. The fear of losing the new Moyo FHRM devices. |
*The healthcare providers always need consent from the family if there is a need for caesarean section. The family’s attitude towards female babies could affect the response time.
CS, caesarean section; DHs, district hospitals; FHRM, fetal heart rate monitor.