Abstract
BackgroundThe 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.MethodsUsing 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).ResultsWe 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.ConclusionsThis 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.
Highlights
The majority of women in sub-Saharan Africa deliver in a facility, 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
As a result of this, experts are realizing the importance of exploring the context and content of care in a holistic way, from understanding the quality of services offered at facilities through to patients perceptions of that care [5]
Nesbitt and colleagues used these recommended and expanded set of signal functions to look at facility quality in 86 facilities in Ghana [6]. In this analysis we study the same signal functions used by Nesbitt et al [6] to look at indicators of care in two other African countries, Kenya and Namibia
Summary
The majority of women in sub-Saharan Africa deliver in a facility, 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. An increasing number of women in Sub-Saharan Africa are seeking care for delivery and antenatal care (ANC) services in health facilities [1]. In Low- and Middle-Income Countries growing evidence suggests that despite high levels of deliveries in facilities, maternal and neonatal mortality remains stubbornly high. In India, increasing numbers of women delivering in facilities has not led to any decrease in maternal and neonatal mortality [4]. A few studies have begun addressing this issue by looking in depth at what quality of care indicators for maternal and neonatal emergency care are available at facilities in low income countries. A study of newborn care in hospitals in Kenya found that hospitals generally had only 30 to 56 % of items necessary to care for sick newborns [8]
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