scholarly journals “…This facility has all that is Required for Safe Baby Delivery in Case of An Emergency There is a Theater…” Exploring Experiences and Perceptions of Quality of Maternity Care in a Rural Sub-County. A Qualitative Study

2020 ◽  
Author(s):  
Jackline Akinyi Oluoch-Aridi ◽  
Francis Wafula ◽  
Gilbert O Kokwaro ◽  
Mary B Adam
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Primary Health ◽  
Delivery Services ◽  
Primary Health Facilities

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

scholarly journals The structural quality of maternal health services in primary health care facilities in Tanzania: Findings from a baseline study

2019 ◽  
Author(s):  
Ntuli A. Kapologwe ◽  
Albino Kalolo ◽  
Naomi H. Isanzu ◽  
Josephine Borghi ◽  
Stephen M. Kibusi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Death ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Structural Quality ◽  
Primary Health ◽  
Primary Health Facilities

AbstractBackgroundStructural quality of maternal health services remains a key indicator of highly performing health care system. Evidence attest to the fact that introduction of the new interventions in the health care system does not necessarily lead into improvement of the target outcome, such as quality of health services delivered. This study aimed at assessing the structural quality of maternal health services prior to introduction of Direct Health Facility Financing (DHFF) program.MethodsThis was a cross-sectional study, conducted in 42 public primary health facilities between January and mid February 2018. Observational were used to collect the data from health facilities. The collected information was on privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management. Collected data were analyzed by using SPSS.ResultsAll 42 (100%) primary health facilities that were assessed were public primary health facilities, of which 14 (33.3%) were health centers and 28 were dispensaries. The furthest primary health facilities from the district head office were 140 Kms and the nearest 2 Kms. Focusing on; - privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management assessed eight areas of Structural qualities. Majority (68.9%) of Health Centers has less than 39 skilled staff while some of them they have up to 129 health service providers and majority (92.8%) of Dispensaries have less than 15 staff and some have 1 staff.By comparing Dispensary and Health center performances on structural quality indicated relatively low differences among the attributes assessed. Specifically, they did not show statistical significant differences except for obstetric emergencies (p < .005), sterilization (p=. 034) and overall structural quality (p=. 018). With regard to rural-urban performance on structural quality, there was no statistical significant difference on total performance. Similarly, there was no significant differences between rural and urban health facilities on other assessed attributes of structural quality (p >.05) except for sterilization in which urban facilities performed significantly higher than the rural facilities [M=41.2, SD=27.7, 61.3, SD=28.4, respectively (p= .028)]. On the other hand, marginal differences were observed on individual assessed attributes. For examples, rural facilities performed relatively higher than urban ones on privacy (41.2 and 32.0), maternal death reviews (31.4 and 30.7) and waste management (49.0 and 47.3) respectively.ConclusionGenerally facilities performed low on the structural quality indicators of maternal health services provision however; they had high performance on sterilization and emergence obstetric care.

scholarly journals Reducing Maternal Mortality: A Qualitative Study of Health Workers’ Expectation in Urban Area, Indonesia

2021 ◽  
Vol 9 (T4) ◽  
pp. 18-26
Author(s):  
Arlina Dewi ◽  
Sri Sundari ◽  
Nursetiawan Nursetiawan ◽  
Supriyatiningsih Supriyatiningsih ◽  
Dianita Sugiyo ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Urban Area ◽  
Urban Areas ◽  
Health Workers ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Integrated System

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.

Impact of BACIS Program on Quality of Care

2021 ◽  
pp. 136-155
Keyword(s):  
Public Health ◽  
Quality Of Care ◽  
Maternal Health ◽  
Qualitative Study ◽  
Health Services ◽  
Health Informatics ◽  
Maternal Health Services

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.

scholarly journals The Kualitas Pelayanan Berhubungan Dengan Kepuasan Peserta Jkn Di Fasilitas Kesehatan Tingkat Pertama Provinsi Daerah Istimewa Yogyakarta

2019 ◽  
Vol 22 (3) ◽  
Author(s):  
Sri Sularsih Endartiwi ◽  
Pramukti Dian Setianingrum
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Random Sampling ◽  
Health Facilities ◽  
Cross Sectional ◽  
Participant Satisfaction ◽  
Primary Health ◽  
Quality Of Health Services ◽  
Primary Health Facilities

BPJS Health targets participant satisfaction to reach 95%, but until 2017 participant satisfaction reaches 85%. Participants who received service at the primary health facilities based on observations averaged 70%. Based on observations at the primary health facility can be seen that participant satisfaction is 70%. The objective was to evaluate the correlation between the quality services and participant satisfaction on the national health insurance at primary health facilities in the province of Yogyakarta. The type of research was quantitative descriptive with cross sectional design. The research location was primary health facilities that cooperate with BPJS Kesehatan in the Province of Yogyakarta. The study was conducted in July 2018. The number of samples in this study was 850 by proportional random sampling. Data analysis was using the Kendall Tau test. Results showed that the quality of health services both in terms of tangible, reliability, responsiveness, assurance and empathy were related to the satisfaction of BPJS Kesehatan participants in the primary health facilities. The results of bivariate analysis for each variable had a Sig. (2-tailed) 0,000 with a strong relationship. The quality of health services was related to the satisfaction of patients participating in the BPJS Kesehatan in the primary health facilities of the Province of Yogyakarta. Primary health facilities in order to maintain the quality of its health services so that patients participating in the National Health Insurance program remain satisfi ed with the services that have been provided. Abstrak BPJS Kesehatan menargetkan kepuasan peserta mencapai 95%, akan tetapi sampai tahun 2017 ini kepuasan peserta mencapai 85%. Peserta yang mendapatkan pelayanan di fasilitas kesehatan tingkat pertama berdasarkan hasil observasi di puskesmas, dokter keluarga dan klinik pratama rata-rata 70%. Berdasarkan hasil observasi di fasilitas kesehatan tingkat pertama (FKTP) yang bekerja sama dengan BPJS Kesehatan dapat diketahui bahwa kepuasan peserta sebesar 70%. Penelitian bertujuan untuk membuktikan bahwa kualitas pelayanan berhubungan dengan kepuasan peserta Jaminan Kesehatan Nasional (JKN) di Fasilitas Kesehatan Tingkat Pertama Di Provinsi Daerah Istimewa Yogyakarta. Jenis penelitian adalah deskriptif kuantitatif dengan rancangan cross sectional. Lokasi penelitian adalah FKTP yang bekerjasama dengan BPJS Kesehatan di Provinsi Daerah Istimewa Yogyakarta. Penelitian dilakukan pada bulan Juli 2018. Jumlah sampel dalam penelitian ini adalah 850 secara proportional random sampling. Analisis data dilakukan dengan menggunakan uji Kendall Tau. Kualitas pelayanan kesehatan baik dari sudut tangible, reliability, responsiveness, assurance maupun empathy berhubungan dengan kepuasan pasien peserta BPJS Kesehatan di FKTP Provinsi Daerah Istimewa Yogyakarta. Hasil analisis bivariat setiap variabel mempunyai nilai Sig. (2-tailed) 0,000 dengan hubungan yang kuat. Kualitas pelayanan kesehatan (tangible, reliability, responsiveness, assurance dan empathy) berhubungan dengan kepuasan pasien peserta BPJS Kesehatan di FKTP Provinsi Daerah Istimewa Yogyakarta. FKTP di Provinsi Daerah Istimewa Yogyakarta supaya tetap mempertahankan kualitas pelayanan kesehatannya sehingga pasien peserta program Jaminan Kesehatan Nasional (JKN) tetap merasa puas terhadap pelayanan yang sudah diberikan.

scholarly journals COVID-19 Effect on Access to Maternal Health Services in Kenya

2020 ◽  
Vol 1 ◽  
Author(s):  
Jackline Oluoch-Aridi ◽  
Tecla Chelagat ◽  
Mary M. Nyikuri ◽  
Joseph Onyango ◽  
Danice Guzman ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Informal Settlements ◽  
Safety Net ◽  
Mitigation Strategies ◽  
Access To Health ◽  
The Impact

Introduction: Maternal mortality continues to be one of the biggest challenges of the health system in Kenya. Informal settlements in Kenya have been known to have higher rates of maternal mortality and also receive maternity services of varied quality. Data assessing progress on key maternal health indicators within informal settlements are also often scarce. The COVID-19 pandemic hit Kenya in March this year and so far, the impact of the pandemic on access to maternal health has not been established. This study aims to add to the body of knowledge by investigating the effects of the COVID-19 pandemic and mitigation strategies on access to health care services in informal settlements.Methods: Qualitative methods using in-depth interviews were used to assess women's experiences of maternity care during the COVID-19 era and the impact of proposed mitigation strategies such as the lockdown and the curfew. Other aspects of the maternity experience such as women's knowledge of COVID-19, their perceived risk of infection, access to health facilities, perceived quality of care were assessed. Challenges that women facing as a result of the lockdown and curfew with respect to maternal health access and quality were also assessed.Results: Our findings illustrate that there was a high awareness of the symptoms and preventative measures for COVID-19 amongst women in informal settlements. Our findings also show that women's perception of risk to themselves was high, whereas risk to family and friends, and in their neighborhood was perceived as low. Less than half of women reported reduced access due to fear of contracting Coronavirus, Deprioritization of health services, economic constraints, and psychosocial effects were reported due to the imposed lockdown and curfew. Most respondents perceived improvements in quality of care due to short-waiting times, hygiene measures, and responsive health personnel. However, this was only reported for the outpatient services and not in-patient services.Conclusion: The most important recommendation was for the Government to provide food followed by financial support and other basic amenities. This has implications for the Government's mitigation measures that are focused on public health measures and lack social safety-net approaches for the most vulnerable communities.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

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.

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