Keywords :
Emergency Obstetric Care, First Referral Units, Community Health Centre, Sub District Hospitals.

ABSTRACT
Gujarat State has 163 First Referral Units , among which 110 are functioning optimally and providing all major facilities, 32% of the centers are lacking one of the three Critical facilities for Comprehensive Emergency and Obstetrics Care (CEmOC). A detailed study of major parameters affecting the CEmOC services at each center in all six health regions is important to identify the gaps and fill them for improving the maternal health in Gujarat State.
This Study is based on the field study carried out during March 2011 - April 2012 at all the 163 FRU centers in addition to personal interviews conducted the staff posted at these centers. A questionnaire was circulated among all the FRU staff to obtain information regarding the status of their respective center and assessment of the availability of key facilities for CEmOC. Each center was observed and evaluated in according to the checklists prepared. For validation purposes, this research includes the parameters based on the Guidelines set for operationalization of First Referral Units set by Government of India. Information is collected for Forty two different indicators for each center. This information was then compared with the guidelines and the gaps have been identified on three critical determinants for FRUs which include i) Availability of Specialists manpower for carrying out comprehensive emergency obstetric care. ii) Status of facility based new born care at all FRU centers, iii) Availability of Blood Supply and Blood Storage facility at these centers. Overall, it was found that there was 100% availability of both new born care facility and Blood transfusion facility; however only 68% centers were having availability of specialist manpower.
 
Gujarat State has shown a considerable improvement in the Infant Mortality rate and the Birth Rate over the past few years, thanks to a constant improvement in the comprehensive emergency care given at first referral units. There has been a 30% increase in the total number of C-section deliveries performed at FRUs, However there are many centers which are showing sub-optimal performance; A Gap analysis was performed and gaps were identified in the availability of CEmOC and LSAS Staff, major reasons were found to be inappropriate posting of trained specialists at non-FRU centers and lack of confidence and motivation among the staff posted at FRU. It is recommended that specialists posted at non FRU centers be posted at FRU centers and shall be moved to centres close to their Location