Availability and readiness of routine perinatal and emergency obstetric and newborn care services in health facilities in Burkina Faso: trend analysis from 2014 to 2020

Background Despite significant reductions in recent decades, maternal mortality and stillbirth remain some of the leading causes of death in Burkina Faso. Routine perinatal and emergency obstetric and newborn care (EmONC) can reduce these deaths. This study analyses the trends in availability and health facility readiness to provide routine perinatal and EmONC in Burkina Faso between 2014 and 2020. Methods We conducted a trend analysis of repeated cross-sectional facility-based data using nationally representative 2014, 2016 and 2018 Service Availability and Readiness Assessment surveys and census-based 2020 Health Harmonised Facilities Assessment. Following descriptive analysis of included facilities, we used tracer elements in both surveys to estimate availability and readiness indices by survey year and health facility characteristics. Both indices were calculated using the equal-weighted approach, while the domain-weighted approach was used for readiness only. We assessed trends using a weighted multivariate linear regression, with trends adjusted for facility characteristics. Results Routine perinatal and basic EmONC availability index increased from 69.8% in 2014 to 74.9% in 2020 (\(\:\beta\:=0.825;p<0.001)\). After adjustment for facility characteristics, there was a statistically significant increment in routine perinatal and basic EmONC availability index from 2014 to 2020 in primary and public facilities, and in those in seven of 13 regions, but significant decline in urban-based facilities. There was also a significant reduction in readiness score for this service (65.0% in 2014 to 61.1% in 2020 (\(\:\beta\:=-0.515;p<0.001)\)), driven mostly by staff and guidelines. Adjusted trends showed statistically significant reduction in readiness index in secondary, tertiary, and private facilities. Availability index for comprehensive EmONC had a non-significant decline from 82.9% in 2014 to 79.6% by 2020, while its readiness score declined significantly, from 62.5% in 2014 to 46.5% in 2020 (\(\:\beta\:=-1.981;p<0.001)\), driven by all domains. Adjusted trends showed statistically significant reduction in secondary, tertiary, public, private, and urban-based facilities. Conclusion While availability of routine perinatal and EmONC services have mostly withstood effects of recent health system shocks, facilities’ readiness to provide these services declined. Staff capacity development and equipping of hospitals are needed to ensure that hard gains made in maternal mortality and stillbirth reductions in Burkina Faso are not reversed.