Type of health care workers and quality of antenatal and delivery care in communities of Myanmar: An experience- and vignette-based study.

Abstract

Understanding who provides antenatal and delivery care services and the quality of care in communities with high maternal deaths is essential for planning the efficient utilization of a limited health care workforce. To identify the types of health care workers for antenatal and delivery care in these communities, and assess the quality of care using vignettes of women with hypertensive disorder in pregnancy (HDP) and postpartum hemorrhage (PPH) from the provider's perspectives in Myanmar. A cross-sectional study was conducted in three townships of Myanmar during May to September 2016. Health assistants, lady health visitors, midwives, and auxiliary midwives rated the type of providers and quality of care based on four HDP vignettes and four PPH vignettes. The agreements of their assessments were analysed using prevalence-adjusted bias-adjusted kappa and Cramer's V coefficient. Almost perfect agreement was found that midwives were the providers who provided and who should provide all routine antenatal and delivery care services. Less than 80% of the participants perceived good quality antenatal care (ANC) and delivery care for HDP and PPH, particularly in vignettes featuring cases of pre-existing hypertension or PPH with history of hospitalization. More than 85% of the participants rated quality of care for managing complications as good. Variations of ratings among the providers ranged from small to medium (Cramer's V = .22-.40). Midwives were key providers of ANC and delivery care in the local communities in Myanmar, but the quality of ANC for women with HDP and PPH was poor and needs improvement.