Raising concerns: Quality of care in maternal health services in South Africa

2014 ◽  
Vol 8 (4) ◽  
pp. 177-181 ◽  
Author(s):  
Rachelle Chadwick

The BACIS program was developed then implemented and evaluated. There was an overall improvement in compliance from 85.1% to 89.3% after its introduction. This result was not statistically significant. However, when results were stratified into specific categories, the BACIS program showed statistically significant improvement in compliance over the checklist system in three out of nine important categories. These are compliance at booking, patients younger than 18 years, and patients booking after week 20. Furthermore, a qualitative study was undertaken to understand reasons for non-compliance with the maternal health guidelines. These results, insights, and experiences are valuable to the communities of health, public health, and health informatics persons who are practitioners or researchers in the area of addressing issues of quality in maternal health services.


2020 ◽  
Author(s):  
Jackline Akinyi Oluoch-Aridi ◽  
Francis Wafula ◽  
Gilbert O Kokwaro ◽  
Mary B Adam

Abstract Background Maternal mortality still remains a big health system challenge in Kenya. Free maternity policy resulted in an increase in Facility-based delivery. However, this has not been accompanied with a reduction in maternal mortality. This research aims at establishing women’s experiences and perceptions with regard to the quality of maternal health services received at health facilities during delivery. This contextual knowledge will assist policy makers to better understand patterns of health system utilization critical for forging strategies for reducing inequities and providing high quality maternal care.Methods Women aged between 18 and 49 who had recently delivered and were attending six-week immunization clinics were purposively selected at six different health facilities and focus group discussions were conducted with the women. The data was analyzed using thematic content analysis. Verbatim excerpts from the women were provided to illustrate the themes identified. The WHO vision for quality of care was used to assess the themes on experiences of care described by the womenResults Six themes were identified as facilitators to access maternal health services 1) Perceived quality of delivery services 2) Financial access to delivery services 3) Referrals to public tertiary health facilities 4) Social influence 5) operation times at public primary health facilities 6) Distance to the health facility. A few barriers were identified under the perceived quality of services most prominent been the mistreatment of women by night-shift nurses and the operation time at the primary health facilitiesConclusion The findings suggest that the rural women tend to prefer tertiary maternity health facility and there are a number of factors related to quality of care based on their experiences that predispose their choices. Most prominent was the availability of equipment such as theatres for obstetric complications. Another emerging issue was respectful care during maternity services. Auxiliary costs still present a challenge despite the free maternity services. Future studies need to focus on ensuring in depth contextual understanding of women’s perceptions of the experience of care with regard to patient-centered care. Understanding these aspects will help in forging strategies to reduce inequities that are leading to high maternal mortality


2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.


2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Sheetal P Silal ◽  
Loveday Penn-Kekana ◽  
Bronwyn Harris ◽  
Stephen Birch ◽  
Diane McIntyre

2021 ◽  
Vol 2 ◽  
Author(s):  
Siri Aas Rustad ◽  
Helga Malmin Binningsbø ◽  
Haakon Gjerløw ◽  
Francis Mwesigye ◽  
Tony Odokonyero ◽  
...  

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value < 0.05) but are 8% points more likely to give birth at a health facility (p-value < 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value < 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value < 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.


2021 ◽  
Vol 9 (T4) ◽  
pp. 18-26
Author(s):  
Arlina Dewi ◽  
Sri Sundari ◽  
Nursetiawan Nursetiawan ◽  
Supriyatiningsih Supriyatiningsih ◽  
Dianita Sugiyo ◽  
...  

BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality. AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas. METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising. RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity. CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.


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