Abstract
BackgroundMany policy makers at country level in both medium and low to middle-income countries still have great difficulty deciding which quality intervention would have the greatest impact on the health outcomes delivered by their health systems.AimTo investigate women’s perceptions about the factors that hinders or facilitates the provision of quality childbirth services in Ghana’s health care services to guide improvement efforts.SettingThe study was conducted in the greater Accra region of Ghana in two primary level hospitals (district hospitals).MethodsA qualitative study design, which is exploratory, descriptive and contextual in nature, was used. Semi-structured interviews were used to examine the perspectives of 15 women on the factors that influence the quality of childbirth services and how services could be improved in Ghana. Data were analysed through data reduction, data display and generation of themes.ResultsThe findings in this study revealed two major themes, firstly, barriers to quality childbirth with five subthemes: high workload, shortage of health workers, non-availability of some services, as well as poor coordination, unacceptable staff behaviour and lack of cooperation from some clients, were identified by the participants as the major causes of poor quality. Secondly, ways to improve care reported, were encouraging health workers to be patient with clients, promoting open communication, friendliness and attentiveness. The need to reorganise service provision to make it more client centred, was also highlighted.ConclusionThe study findings highlight the importance of paying attention to factors such as service organisation and coordination, high workload, inadequate number of staff, as well as limitations in infrastructure and logistics for quality services delivery. Equally important are institutionalisation of systems to continuously assess and improve staff competence and attitudes and the creation of an environment that can foster good interpersonal relationship between health care providers and patients.
Highlights
The need to continuously search for mechanisms to address health care quality cannot be understated
This view is supported by Raven et al.[3] whom stated, ‘...that quality care standards should be limited to professional standards and be acceptable to women and their families’
In a study to identify why women refused to deliver in hospitals in Brazil, Jamas et al.[6] reported the following reasons: inadequate beds, lack of accommodation for companion, inadequate privacy, services not designed to meet the individual needs of women, performance of unnecessary procedures and http://www.phcfm.org
Summary
The need to continuously search for mechanisms to address health care quality cannot be understated. This need is evident even in well-developed and resourced health systems.[1] With regards to developing countries, effective implementation of quality actions is constrained by inadequate resources and by seemingly lack of quality measurement systems. The definition highlights quality of care provision and quality of care experienced by the user. This view is supported by Raven et al.[3] whom stated, ‘...that quality care standards should be limited to professional standards and be acceptable to women and their families’. Many policy makers at country level in both medium and low to middle-income countries still have great difficulty deciding which quality intervention would have the greatest impact on the health outcomes delivered by their health systems
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