Abstract
BackgroundComputerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana.MethodsWe employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline.ResultsThe combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant.ConclusionThis combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.
Highlights
Maternal health services, quality, and client satisfactionMaternal and neonatal mortality statistics have improved globally, but remain poor
We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey
The combined Computerized decision-support systems (CDSS)-performance-based incentives (PBIs) intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline
Summary
Quality, and client satisfactionMaternal and neonatal mortality statistics have improved globally, but remain poor. The annual neonatal mortality rate is approximately 18/1,000 live births, while the maternal mortality ratio is 216 deaths per 100,000 live births [1]. An estimated 99% of maternal deaths occur in low and middle-income countries (LMICs), more than half in sub-Saharan Africa [1]. In Ghana, the maternal mortality ratio is 319 deaths per 100,000 live births and the neonatal mortality rate is 25 deaths per 1,000 live births [2]. The 2014 Ghana Demographic and Health Survey estimated that 73% of births occurred in health facilities, with lower rates in poorer regions [3].
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