Date Published: October 15, 2018
Publisher: Public Library of Science
Author(s): Belay Erchafo, Tesfamichael Alaro, Gebeyehu Tsega, Ayinengida Adamu, Kiddus Yitbarek, Yibeltal Siraneh, Meaza Hailu, Mirkuzie Woldie, Sharon Mary Brownie.
Quality of service provision in health facilities is fundamental to ensure effective care. However, women’s actual experience of care is often neglected.
To assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia.
Community based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions.
Perceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (β: -0.331, 95% CI: -0.523, -0.140), urban residence (β: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (β: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (β: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (β: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (β: -0.689, 95% CI: -0.907,-0.472). Urban residence (β: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (β: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure.
Overall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.
Developing regions account for approximately 99% (302,000) of the global maternal deaths which is roughly 20 times higher than that of developed regions, whereas sub-Saharan Africa (SSA) alone accounting for roughly 66% (201,000) [1,2]. In Ethiopia, according to recent World Health Organization (WHO) estimate proportion of mothers who were dying to give 100,000 live births has declined to 353 in 2015 from 420 in 2013. Achieving the SDG target of a global Maternal Mortality Ratio (MMR) below 70 will require reducing global MMR by an average of 7.5% each year between 2016 and 2030 . This requires more than three times the 2.3% annual rate of reduction observed globally between 1990 and 2015 .
We found that the percentage mean scores of perceived quality of institutional delivery service ranged from 58% to 70% based on which sub-scale was used to measure it. While the least perceived level of quality was reported for the health facility/structure sub-scale, the highest percentage was reported for perceived quality of health care delivery. Higher percentage was reported for this dimension because perception about health care delivery could be influenced by the fact that maternal health services including delivery care are exempted from payment in Ethiopia. However, the structure/facility component would get a much lower score since public health facilities are poorly equipped with the necessary supplies and equipment.
Findings we have reported inhere imply that quality of institutional delivery care (perceived quality of interpersonal interaction and health facility structure) in public health facilities of the study area was not appealing to the clients. However, the perception of the women about the health care delivery process was reassuring. Building on the positive perception about the process of health care delivery by coaching and mentoring health care providers to improve interpersonal interaction during care will be helpful. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.