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Future roll-out will include more time and funding to ensure a higher proportion of facility staff is reached.
Other studies suggest that most maternal deaths occur in facilities, but this evidence relies heavily on facility records or studies from countries with a higher proportion of facility deliveries rather than population data from poor rural communities [ 20].
Although Nairobi province has a much higher proportion of facility deliveries compared with the national average (89% vs 44%) in the 2008/09 Kenya Demographic and Health Survey (KDHS), there is an economic gradient in which the wealthiest quintile had an extremely high percentage of facility deliveries (98%) compared with a much lower proportion (73%) among the poorest quintile.
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Addis Ababa has a much higher proportion of facility-based births (82%) than the national average (11%), but timely provision of quality emergency obstetric care remains a significant challenge for reducing maternal mortality and improving maternal health.
However, a high proportion of facility deliveries is not unusual in urban areas within sub-Saharan Africa.
For instance, a study in Kenya [ 22] and one in Burkina Faso [ 23] reported that a high education level was associated with a high proportion of facility deliveries.
This is a high proportion of facility deliveries and low proportion of home deliveries in comparison to findings of the Kenya DHS (national estimate, 42.6% facility deliveries and 56.2% home deliveries) [ 9].
Higher proportions of facilities had missing data for specific, common non-HIV clinical services, for example TB and malaria treatment; and these are consequently omitted from the findings.
In municipalities a high proportion of facilities remitted income to either the Nairobi Health Management Board or elsewhere, with only 35.4% of municipal health centres and 33.3% of municipal dispensaries retaining user fee revenues at the facility level.
These results also reveal the important role that generators have in powering health facilities in some sub-Saharan African countries, while at the same time reflecting their unreliability, evident in the high proportion of facilities reporting generators not functioning or lacking fuel.
A higher proportion of medical facilities with a registered dental clinic reported routine collaboration with a dental facility than those not having a registered dental clinic (p <0.01, chi-square test; Figure 3).
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