Quality Of Maternal Health Care Services Research Articles

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective: This study aimed to understand the affordability, accessibility, and quality of maternal and child health services for postpartum mothers, and their impact on satisfaction. Methods: The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire. A survey was conducted among 289 mothers aged 20–49 in Feicheng City. Results: Regarding accessibility, most respondents (133) reported that travel time to healthcare services exceeded 60 minutes, while 99 respondents indicated a travel time of 16–30 minutes. The issue of affordability was highlighted, with 86.85% of participants perceiving maternal healthcare services as costly, indicating a significant financial burden. More than 50% of respondents were satisfied with two specific dimensions (P < 0.05) regarding the quality of maternal healthcare services. Conclusion: The study found that accessibility, affordability, and quality significantly affect mothers’ satisfaction with maternal health services. Future research should focus on developing more suitable service pathways for rural mothers.

Effects of free maternal healthcare on stunting in children under five years of age: Evidence from Ghana

AbstractMotivationAddressing stunting in early childhood can have lasting effects on an individual's health, productivity, and well‐being in adulthood. By understanding the relationship between maternal healthcare policies and stunting, policy‐makers can design interventions that contribute to a healthier and more productive society.PurposeThis study investigated the effect of providing free healthcare to pregnant mothers on child stunting.Approach and methodThe article uses doubly robust difference‐in‐difference estimator, drawing on Ghana Demographic and Health Survey.FindingsFree healthcare to mothers reduced stunting in the treatment regions by 12.3%. Evidence suggests the reform may have influenced children under the age of five through antenatal and delivery care attendance during pregnancy. Assistance during antenatal care and childbirth by health professionals improved significantly.Policy implicationsMaternal health investment yields great health benefits for children from in utero to their fifth birthday. Maternal fee exemptions should be continued to maintain and further improve stunting reduction in children. Government should prioritize improving access to quality maternal healthcare services, including antenatal and skilled birth attendance and emergency obstetric care.

Exploring Perceptions and Experiences about Maternal Health Services: A Community-Level Initiative in Jampur

The aim of the study is to scrutinize the availability and quality of maternal healthcare services by reconnoitering the perceptions and experiences about health facilities, encountered by women residing in tehsil Jampur. The current investigation employed qualitative methodology and obtained data from a sample of 28 participants including both health services seekers and health services providers, by using purposive sampling. The data was gathered through comprehensive interviews and focus group discussions (FGDs). The researcher used deductive thematic analysis methodology to analyze the data. To enhance the validity of information gathered through research, perceptions of both health service-providers as well as health service-seekers was taken encountered. The research emphasizes the significance of addressing unprofessional behavior, transportation deficiencies, insufficient substructure, and erratic working schedules to improve health outcomes. Additionally, service quality evaluation at facility centers is important due to various deficiencies observed at healthcare center. The challenges include limited availability of medicine, limited operating hours of medical services, inadequate transportation options to remote healthcare facilities, and a shortage of female healthcare providers at community level, influenced by cultural norms surrounding gender subtleties. The administration of the health department is adversely affected by the repetitive vacillations in government and its systematic framework. The health department encounters instability due to the diverse strategies, programs, and staff appointments executed by successive prime ministers. Study suggest dire need of sorting out these issues to ensure native’s trust on available health facilities and to improve overall health upshots.

Strategies to Reduce Maternal Death Rate and Improve the Provision of Quality Healthcare Services in Selected Hospitals of Vhembe District Limpopo Province.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in the maternal mortality rate was reported between 2020 and 2021, with Limpopo ranking fourth highest out of nine provinces. The Vhembe district maintained its position as the third-ranked area with a notably elevated maternal mortality rate. This study aimed to explore the strategies used to reduce the maternal death rate and improve the provision of quality maternal healthcare services based on participant experiences in selected hospitals of the Vhembe district, Limpopo Province. One hospital was purposively sampled from every four municipalities. A qualitative approach using a phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data, complemented by the use of an audio recorder, continuing until data saturation was reached. Data saturation was reached at the 20th participant; however, the researcher continued until 28 sampled participants were interviewed. An interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). The results indicate that, despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as the lack of material resources, shortage of staff, incompetent staff and poor infection control, affect the quality of maternal health services in the Vhembe district. The Limpopo Department of Health and hospital management should ensure that hospitals have all the necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

An exploration of health workers’ experiences in providing bereavement care to mothers following a stillbirth: results from a subnational level health system in Uganda

BackgroundStillbirth is a profound emotion-laden event to the mothers and health workers who provide care due to its sudden and unexpected occurrence. Health workers offering support in regions shouldering the highest-burden experience providing support to a stillbirth mother in their professional lifetime. However, their experiences seldom get documented as much of the focus is on mothers causing a dissonance between parental and clinical priorities. This study aimed to explore the health worker’s experiences in the provision of bereavement care to mothers following a stillbirth.MethodsAn exploratory cross-sectional qualitative study was undertaken on a purposively selected sample of key informants drawn from frontline health workers and health systems managers providing maternal health services at a subnational level health system in Uganda. An interview guide was used to collect data with the audio-recorded interviews transcribed using Microsoft office word. Atlas. ti a qualitative data management software aided in coding with analysis following a thematic content analysis technique.ResultsThere was no specialised bereavement care provided due to inadequate skills, knowledge of content, resources and support supervision for the same. However, health workers improvised within the available resources to comfort mothers upon news of a stillbirth. Disclosure to mothers about the stillbirth loss often took the form of forewarnings, direct and sometimes delayed disclosure. A feeling of unpreparedness to initiate the disclosure process to the mother was common while the whole experience had an emotional effect on the health workers when establishing the cause, particularly for cases without clear risk factors. The emotional breakdown was often a reflexive response from the mothers which equally affected the care providers. Health workers engaged in comforting and rebuilding the mothers to transition through the loss and validate the loss. Efforts to identify the skills and health systems gaps for address were a common response targeted at improving the quality of maternal healthcare services to avert similar occurrences in the future.ConclusionProviding care to mothers after stillbirth was an emotional and challenging experience for health workers requiring different approaches to disclosure and provision of emotional support. The aspect of specialised bereavement care was lacking within the current response. Reflection of unpreparedness to handle the tasks demonstrates a deficit in the required skills. It is a critical gap missing hence calling for dedicated efforts to address it. Targeting efforts to improve health workers’ competencies and preparedness to manage grieving mothers is one way to approach it.

تقييم تصور األمهات لخدمات األمومة الصحية في المناطق الريفية في يطا، الخليل: دراسة تجريبية في فلسطين

Access to high-quality care during pregnancy and childbirth is a challenge for women living in Al-Masafer of Yatta and Bedouin areas, considered C areas under Israeli administrative & security supremacy. Realizing clients' perception and satisfaction with the quality of maternal healthcare services will enable maternal health decision-makers & providers to assess the impact of their services on the clients' demands and perceptions. This study aims to measure women's perception of maternal health services provided in Al- Masafer of Yatta and Bedouin areas. A cross-sectional descriptive quantitative study of 59 women, selected purposefully from Al-Masafer of Yatta and the Bedouin areas, was conducted in September 2021. The mean age of the respondents was 28 years, with a range of 23-34 years old. After investigating their Perception of Maternal Health Services in Al-Masafer of Yatta, the mean of their answers was as the following: provided services: 2.87 was moderate, the professional treatment: 2.80 was moderate, degree of obstacles facing women in access to reproductive health services: 3.50 was moderate, and health promotion provided to women: 1.92 was low, while the total overall mean 3.01 was moderate. Despite the obstacles faced by women to reach maternal health centers, the overall level of health care provided at maternal health centers was modest in both Al-Masafer of Yatta and the Bedouin areas.

Health-related quality of life

Quality of life (QoL) is a multidimensional concept and an essential health component that usually includes both positive and negative aspects of life. The measure of health-related QoL (HRQOL) enables health agencies and social partners to address areas of public health importance and formulate policies which eventually demonstrate the impact of health on QoL. Women form an important pillar of society as they are the primary caretaker of children and elders in every country of the world and therefore, the QoL of women determines the health of the next generation and future public health challenges for families, communities, and the health-care system. Providing health services at par with quality is the need of the hour and a very important health goal considering women's health. Poor delivery of clinical care, failure to meet the professional standards of patient care by health-care providers, mistreatment and abuse by health-care professionals, and inequitable delivery of care are some of the key issues in the delivery of quality maternal health-care services in India and therefore primary health-care professionals should be made familiar with the concept of the HRQoL in the community they are serving. Indian health-care systems need to address to the inequalities and taking off the consumer-centric, market approach of privately run corporate health facilities along with setting up of accountability of all the stakeholders to provide quality care, especially in the government-run facilities and creating a promising environment in health care for women focusing on pregnant and postpartum mothers.

Influence of women's decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria: evidence from the Nigeria Demographic and Health Survey 2018

BackgroundIn the context of global health priority, understanding the role of power dynamics among women as an important intervention required towards achieving optimum maternal and child health outcomes is crucial. This study examined the influence of women's decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 20,100 births in the last five years that preceded the survey among married/cohabiting childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using the binary logistic regression model.ResultsThe study revealed that despite a large number of women initiating antenatal care visits before 12 weeks of pregnancy (75.9%), far fewer numbers had at least eight antenatal care visits (24.2%) and delivered in a health facility (58.2%). It was established that the likelihood of having at least eight antenatal care visits was significantly increased among women who enjoyed decision-making autonomy on their healthcare (aOR: 1.24, CI: 1.02–1.51) and how their earnings are spent (aOR: 2.02, CI: 1.64–2.48). Surprisingly, women’s decision-making autonomy on how their earnings are spent significantly reduced the odds of initiating antenatal care visits early (aOR: 0.75, CI: 0.63–0.89). Some socio-economic and demographic factors were observed to have a positive influence on quality antenatal care utilisation and delivery in a health facility.ConclusionIn conclusion, women’s decision-making autonomy on their healthcare and how their earnings are spent was significantly found to be protective factors to having eight antenatal care visits during pregnancy. Conversely, women’s autonomy on how their earnings are spent significantly hindered their initiation of early antenatal care visits. There is a need for more pragmatic efforts through enlightenment and empowerment programmes of women to achieve universal access to quality maternal healthcare services in Nigeria.

تقييم تصور الأمهات لخدمات الأمومة الصحية في المناطق الريفية في يطا، الخليل: دراسة تجريبية في فلسطين

Access to high-quality care during pregnancy and childbirth is a challenge for women living in Al-Masafer of Yatta and Bedouin areas, considered C areas under Israeli administrative & security supremacy. Realizing clients' perception and satisfaction with the quality of maternal healthcare services will enable maternal health decision-makers & providers to assess the impact of their services on the clients' demands and perceptions. This study aims to measure women's perception of maternal health services provided in Al- Masafer of Yatta and Bedouin areas. A cross-sectional descriptive quantitative study of 59 women, selected purposefully from Al-Masafer of Yatta and the Bedouin areas, was conducted in September 2021. The mean age of the respondents was 28 years, with a range of 23-34 years old. After investigating their Perception of Maternal Health Services in Al-Masafer of Yatta, the mean of their answers was as the following: provided services: 2.87 was moderate, the professional treatment: 2.80 was moderate, degree of obstacles facing women in access to reproductive health services: 3.50 was moderate, and health promotion provided to women: 1.92 was low, while the total overall mean 3.01 was moderate. Despite the obstacles faced by women to reach maternal health centers, the overall level of health care provided at maternal health centers was modest in both Al-Masafer of Yatta and the Bedouin areas.

Expectations and experiences of women regarding maternal healthcare services in Pakistan: challenges and lessons to be learnt

BackgroundAccess to maternal healthcare services is an essential pre-requisite for improving women’s health. However, due to poor access and underutilization, women in developing countries remain vulnerable to various complications. Evaluation of quality maternal healthcare services in any country must include the opinions of the women being as a key stakeholder utilizing maternal healthcare services.AimThe present study was designed to evaluate the experiences, perceptions and expectations of pre-birth and post-birth women regarding utilization and delivery of maternal healthcare services in Pakistan.MethodologyA qualitative study design was used. Snow ball sampling technique was adopted to identify the respondents. Interviews were conducted using semi-structures interview guide till saturation point was achieved. The sample size at saturation point for different respondents was: pre-birth women (n = 9) and post-birth women (n = 9). All interviews were recorded after getting permission from the respondents. The interviews were transcribed verbatim and were then subjected to thematic analysis.ResultsThe age group for the pre-birth respondents was 23–43 years while for post-birth group it was 23–32 years. Most of the respondents from both groups were from urban setting. Most of them were either first time pregnant or were having experience of one pregnancy. Thematic analysis of the interviews yielded different themes and sub-themes including birth experience, maternal treatment pathway, identified barriers for quality maternal care, involvement in healthcare decision-making, impact of Covid 19, payment dynamics, role of digital health and recommendations for improving maternal care services.ConclusionThe results of the present study concluded that the overall quality of the maternal care services provided in Pakistan was not up to the mark. High rate of caesarian section was prevalent. Majority of the women were not involved in the decision-making process or provided with any birth plan or counselling regarding birth signs, family planning, danger and birth signs. The cost of maternal care was quite high and not affordable for all.

Situation of labour room documentation at secondary level public health facilities of Cuttack district, Odisha, India - A SWOT analysis.

Background:Poor documentation practices in labour rooms have been a challenge especially in resource limited countries. This hinders the efforts towards improving quality of maternal healthcare services. Little effort has been made on this regard in many countries including India. SWOT analysis on labour room documentation would be the first step in understanding the situation, barriers and to formulate strategies for improvement.Materials and Methods:Facility based cross-sectional study was carried out in five secondary health facilities of Cuttack district, Odisha, India. A qualitative method using in-depth interviews among 26 healthcare providers was adopted for data collection and inductive content analysis approach for analysis. Strategies like pioneering, positive, conservative and resistive were formulated under each of the three major components identified.Results:Three major components emerged were i) Adherence and completeness of labour room records and reports, ii) Status of the monitoring and supervision and iii) Utilization of labour room data. Improving knowledge and skill through training and supportive supervision, adopting computer-based application for data management, better coordination among supervisors and labour room staff, infrastructural strengthening for documentation and its security, making documentation a priority, more accountability would improve the documentation. Ensuring data analysis and interpretation, discussion in review meetings and regular monitoring and supervision will improve performance.Conclusion:Ensuring documentation of labour room records, regular quality monitoring and supervision, and analysis and interpretation of data are critical to improve labour room performance. Making it a priority and adopting the strategies will achieve the same, thereby better labour outcome.

Satisfaction with Maternal Healthcare Services in the Ketu South Municipality, Ghana: A Qualitative Case Study.

Background Women's satisfaction with maternal healthcare services is vital in quality healthcare delivery. However, the dearth of in-depth information on the issue is a challenge in Ghana. In this study, we explore women's satisfaction with maternal care services at a health facility in the Ketu South Municipality, Ghana. Methods This is a qualitative study that used a purposive sampling technique to select 15 women who attended a child welfare clinic at the facility for in-depth interviews. The interviews were tape-recorded, and the results presented in quotes in accordance with the themes that emerged. Results The study found that respondents were generally satisfied with the quality of maternal healthcare services provided to them. However, they were dissatisfied with drug administration procedures at the facility. Respondents generally reported poor attitudes on the part of healthcare providers at the health facility. Some logistics were also reported to be in unfavorable condition. Nonetheless, respondents generally had positive perceptions about maternal care services provided to them by the healthcare facility. Conclusions Drug administration procedures and attitude of healthcare providers toward clients as well as logistics need to be improved to enhance satisfaction with services at the health facility, particularly among pregnant women and mothers.

Is quality of care during childbirth consistent from admission to discharge? A qualitative study of delivery care in Uttar Pradesh, India.

BackgroundImproving quality of maternal healthcare services is key to reducing maternal mortality across developing nations, including India. Expanding access to institutionalized care alone has failed to address critical quality barriers to safe, effective, patient-centred, timely and equitable care. Multi-dimensional quality improvement focusing on Person Centred Care(PCC) has an important role in expanding utilization of maternal health services and reducing maternal mortality.MethodsNine public health facilities were selected in two rural districts of Uttar Pradesh(UP), India, to understand women’s experiences of childbirth and identify quality gaps in the process of maternity care. 23 direct, non-participant observations of uncomplicated vaginal deliveries were conducted using checklists with special reference to PCC, capturing quality of care provision at five stages—admission; pre-delivery; delivery; post-delivery and discharge. Data was thematically analysed using the framework approach. Case studies, good practices and gaps were noted at each stage of delivery care.ResultsAdmission to maternity wards was generally prompt. All deliveries were conducted by skilled providers and at least one staff was available at all times. Study findings were discussed under two broad themes of care ‘structure’ and ‘process’. While infrastructure, supplies and human resource were available across most facilities, gaps were observed in the process of care, particularly during delivery and post-delivery stages. Key areas of concern included compromised patient safety like poor hand hygiene, usage of unsterilized instruments; inadequate clinical care like lack of routine monitoring of labour progression, inadequate postpartum care; partially compromised privacy in the labour room and postnatal ward; and few incidents of abuse and demand for informal payments.ConclusionsThe study findings reflect gaps in the quality of maternity care across public health facilities in the study area and support the argument for strengthening PCC as an important effort towards quality improvement across the continuum of delivery care.

An account for barriers and strategies in fulfilling women\u2019s right to quality maternal health care: a qualitative study from rural Tanzania

BackgroundTanzania has ratified and abides to legal treaties indicating the obligation of the state to provide essential maternal health care as a basic human right. Nevertheless, the quality of maternal health care is disproportionately low. The current study sets to understand maternal health services’ delivery from the perspective of rural health workers’, and to understand barriers for and better strategies for realization of the right to quality maternal health care.MethodsSemi-structured in-depth interviews were conducted, involving 11 health workers mainly; medical attendants, enrolled nurses and Assistant Medical Officers from primary health facilities in rural Tanzania. Structured observation complemented data from interviews. Interview data were analyzed using thematic analysis guided by the conceptual framework of the right to health.ResultsThree themes emerged that reflected health workers’ opinion towards the quality of health care services; “It’s hard to respect women’s preferences”, “Striving to fulfill women’s needs with limited resources”, and “Trying to facilitate women’s access to services at the face of transport and cost barriers”.ConclusionHealth system has left health workers as frustrated right holders, as well as dis-empowered duty bearers. This was due to the unavailability of adequate material and human resources, lack of motivation and lack of supervision, which are essential for provision of quality maternal health care services. Pregnant women, users of health services, appeared to be also left as frustrated right holders, who incurred out-of-pocket costs to pay for services, which were meant to be provided free.

Obstetric fistula policy in Nigeria: a critical discourse analysis

BackgroundIn 2012, Nigeria’s Federal Ministry of Health published its National Strategic Framework for the Elimination of Obstetric Fistula (NSFEOF), 2011–2015. The framework has since lapsed and there is no tangible evidence that the goal of eliminating obstetric fistula was met. To further inform future policy directions on obstetric fistula in Nigeria, this paper explores how the NSFEOF conceptualized obstetric fistula and its related issues, including child marriage and early childbearing.MethodsA critical discourse analysis of the policy was performed. We examined four policies in addition to the strategic framework: the Nigerian constitution; the Marriage Act; the Matrimonial Causes Act; and the National Reproductive Health Policy. We used the three phases of critical discourse analysis: textual analysis, analysis of discourse practice, and analysis of discursive events as instances of sociocultural practice.ResultsThe analysis demonstrates that, despite its title, the policy document focuses on reduction rather than elimination of obstetric fistula. The overall orientation of the policy is downstream, with minimal focus on prevention. The policy language suggests victim blaming. Furthermore, the extent to which subnational stakeholders in government and civil society were engaged in decision-making process for developing this policy is ambiguous. Although the policy is ostensibly based on principles of social justice and equity, several rhetorical positions suggest that the Nigerian constitutional environment and justice systems make no real provisions to protect the reproductive rights of girls in accordance with the United Nations’ “2030 Agenda for Sustainable Development.”ConclusionThis analysis establishes that the Nigerian constitution, justice environment and the obstetric fistula policy itself do not demonstrate clear commitment to eradicating obstetric fistula. Specifically, a clear commitment to eradicating obstetric fistula would see the constitution and Marriage Act of Nigeria specify an age of consent that is consistent with the agenda to prevent obstetric fistula. Additionally, a policy to end obstetric fistulas in Nigeria must purposefully address the factors creating barrier to women’s access to quality maternal healthcare services. Future policies and programs to eliminate obstetric fistulas should include perspectives of nurses, midwives, researchers and, women’s interest groups.

Trends in Texas maternal mortality by maternal age, race/ethnicity, and cause of death, 2006-2015.

Maternal mortality is a sentinel indicator of health care quality. Our purpose was to analyze trends in Texas maternal mortality by demographic characteristics and cause of death, and to evaluate data quality. Maternal mortality data were initially analyzed by single years, but then were grouped into 5-year averages (2006-2010 and 2011-2015) for more detailed analyses. Rates were computed per 100000 live births. A two-proportion z test or Poisson regression for numerators <30 was used to evaluate differences. The Texas maternal mortality rate increased from 18.6 in 2010 to 38.7 in 2012, and then declined nonsignificantly to 32.5 in 2015. The 2011-2015 rate (34.2) was 87% higher than the 2006-2010 rate (18.3). In 2011-2015, the maternal mortality rate for women ≥40years (558.8) was 27 times higher than for women <40years (20.7). From 2006-2010 to 2011-2015, the maternal mortality rate increased by 121% for women ≥40years and by 55% for women <40years. The rate increased by 132% for nonspecific causes of death, and by 54% for specific causes. Rates for women <40years for specific causes increased by 36%. The observed increase in maternal mortality in Texas from 2006-2010 to 2011-2015 is likely a result of both a true increase in rates and increased overreporting of maternal deaths, as indicated by implausibly high and increasing rates for women aged ≥40years and among nonspecific causes of death. Efforts are needed to strengthen reporting of death certificate data, and to improve access to quality maternal health care services.

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women.

BackgroundSuboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities.MethodsA cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension.ResultsAll groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05).ConclusionsPerceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities.

Quality assessment of maternal and child health care services at Primary health care level in Kamrup District of Assam.

Background: According to WHO estimates, India contributes about 24 lakhs to 108 lakhs global child deaths and accounts for 25% of the 529,000 global maternal deaths (Reduction of maternal mortality: A joint WHO/ UNFPA/ World Bank Statement: Geneva; 1999). Objective: To assess the quality of maternal and child health care services at primary health care level. Materials and method: The study was conducted in 5 PHCs and 10 S/Cs randomly selected in Kamrup district of Assam. The data was collected from records, interviews of the health personnel and the clients availing the MCH services and lastly by observation method. Results: The quality of MCH services was assessed by using a system approach inputs, process and outputs. Conclusions: The quality of MCH services was found to be average at the primary care level.

Comparison of Maternal Health Service Satisfaction Level of National Health Coverage and Non National Health Coverage Patients in Bandung Mother and Child Hospital

Background: Healthcare is financially inaccessible to some people. This results in deterioration of patients’ condition or even death, which is proven by the high level of Maternal Death Rate in Indonesia. The government implemented the National Health Coverage (NHC) system to ensure the provision of quality health care for the entire community. This study aimed to examine the NHC and non-NHC patients’ perception to quality maternal healthcare services. Methods: This study was an analytic cross-sectional study conducted from August–October 2014. One hundred and twenty six respondents from Kota Bandung Mother and Child Hospital were included. The tool used in this study was a validity and reliability-tested questionnaire encompassing five dimensions of service quality: tangibles, reliability, responsiveness, assurance, and empathy. The Kolmogorov-Smirnov test was used to test the hypothesis. Results: The study showed that the majority of NHC(75%) and non-NHC patients (89%) ware unsatisfied with the maternal healthcare services. Most patients felt unsatisfied towards the reliability dimension which involved complicated referral procedures and examination time that failed to comply with what was promised. Conclusions: There is no difference between NHC and non-NHC patients’ level of satisfaction of maternal health care service in Bandung Mother and Child Hospital. [AMJ.2016;3(3):425–29] DOI: 10.15850/amj.v3n3.869

Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study

This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age (15-45 years), who gave birth within the last year; in-depth interviews comprised traditional leaders, mothers, fathers, community health workers and nurse-midwives. Perspectives on maternal health complications, health-seeking behaviour and barriers to utilization of maternal healthcare were explored. Most women showed insight into maternal health complications. Nevertheless, they started antenatal care visits late and did not complete the recommended schedule. Moreover, most women gave birth at home and did not use postnatal care. The main reasons for the low utilization were the low perceived quality of maternal healthcare services in clinics (negative attitude), negative opinion of important referents (subjective norms), physical and economic barriers such as long distances, high transport and indirect costs including money for baby clothes and other requirements. To improve, our findings suggest need for an integrated intervention to mitigate these barriers. Our findings also suggest need for further research to measure the elicited beliefs and determine their relevance and changeability.