Clinical and perceived quality of care for maternal, neonatal and antenatal care in Kenya and Namibia: the service provision assessment

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Diamond-Smith, Nadia ; Sudhinaraset, May ; Montagu, Dominic (2016)
  • Publisher: BioMed Central
  • Journal: Reproductive Health (vol: 13)
  • Related identifiers: doi: 10.1186/s12978-016-0208-y, doi: 10.13039/100000865, pmc: PMC4981972
  • Subject: Delivery | Obstetrics and Gynaecology | Reproductive Medicine | Maternal health | Quality of care | Large nationally representative datasets | Research | Sub-Saharan Africa

Background The majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient’s perception of their experiences. Methods Using data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn care (EmNC), and antenatal care (ANC) using descriptives and multivariate regression. We explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we see if patient satisfaction (taken from exit surveys at antenatal care) is associated with the quality of services (specific services provided). Results We find that most facilities do not have all of the signal functions, with 46 and 27 % in Kenya and 18 and 5 % in Namibia of facilities have high/basic scores in routine and emergency obstetric care, respectively. We found that hospitals preform better than centers in general and few differences emerged between public and private facilities. Patient perceptions were not consistently associated with services provided; however, patients had fewer complaints in private compared to public facilities in Kenya (−0.46 fewer complaints in private) and smaller facilities compared to larger in Namibia (−0.26 fewer complaints in smaller facilities). Service quality itself (measured in scores), however, was only significantly better in Kenya for EmOC and EmNC. Conclusions This analysis sheds light on the inadequate levels of care for saving maternal and newborn lives in most facilities in two countries of Africa. It also highlights the disconnect between patients’ perceptions and clinical quality of services. More effort is needed to ensure that high quality supply of services is present to meet growing demand as an increasing number of women deliver in facilities.
  • References (27)
    27 references, page 1 of 3

    1. Diamond-Smith N, Sudhinaraset M. Drivers of facility deliveries in Africa and Asia: regional analyses using the demographic and health surveys. Reprod Health. 2015;12(1):6.

    2. The Nambia Ministry of Health and Social Services (MoHSS) and ICF International. The Namibia Demographic and Health Survey 2013, Windhoek, Namibia, and Rockville. Maryland: MoHSS and ICF International; 2014.

    3. Kenya National Bureau of Statistics, Ministry of Health, National AIDS Control Council, Kenya Medical Research Institute, National Council for Population and Development, The DHS Program, ICF International. The Kenyan Demographic and Health Survey 2014. Nairobi, Kenya and Rockville, Maryland, USA; 2015.

    4. Randive B, Diwan V, De Costa A. India's conditional cash transfer programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality? PLoS One. 2013;8(6):e67452.

    5. Graham WJ, Varghese B. Quality, quality, quality: gaps in the continuum of care. Lancet. 2012;79(9811).

    6. Nesbitt RC, Lohela TJ, Manu A, Vesel L, Okyere E, Edmond K, et al. Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana. PLoS One. 2013;8(11):e81089.

    7. Kyei NNA, Chansa C, Gabrysch S. Quality of antenatal care in Zambia: a national assessment. BMC Pregnancy Childbirth. 2012;12(1):151.

    8. English M, Ntoburi S, Wagai J, Mbindyo P, Opiyo N, Ayieko P, et al. An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context. Implement Sci IS. 2009;4:42.

    9. Donabedian A. The quality of care: How can it be assessed? JAMA. 1988;260(12):1743-8.

    10. Gabrysch S, Civitelli G, Edmond KM, Mathai M, Ali M, Bhutta ZA, et al. New signal functions to measure the ability of health facilities to provide routine and emergency newborn care. PLoS Med. 2012;9(11):e1001340.

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