scholarly journals The structural quality of maternal health services in primary health care facilities in Tanzania: Findings from a baseline study

2019 ◽  
Author(s):  
Ntuli A. Kapologwe ◽  
Albino Kalolo ◽  
Naomi H. Isanzu ◽  
Josephine Borghi ◽  
Stephen M. Kibusi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Death ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Structural Quality ◽  
Primary Health ◽  
Primary Health Facilities

AbstractBackgroundStructural quality of maternal health services remains a key indicator of highly performing health care system. Evidence attest to the fact that introduction of the new interventions in the health care system does not necessarily lead into improvement of the target outcome, such as quality of health services delivered. This study aimed at assessing the structural quality of maternal health services prior to introduction of Direct Health Facility Financing (DHFF) program.MethodsThis was a cross-sectional study, conducted in 42 public primary health facilities between January and mid February 2018. Observational were used to collect the data from health facilities. The collected information was on privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management. Collected data were analyzed by using SPSS.ResultsAll 42 (100%) primary health facilities that were assessed were public primary health facilities, of which 14 (33.3%) were health centers and 28 were dispensaries. The furthest primary health facilities from the district head office were 140 Kms and the nearest 2 Kms. Focusing on; - privacy, hygiene and sanitation, obstetric emergences, sterilization, maternal death audit reviews and waste management assessed eight areas of Structural qualities. Majority (68.9%) of Health Centers has less than 39 skilled staff while some of them they have up to 129 health service providers and majority (92.8%) of Dispensaries have less than 15 staff and some have 1 staff.By comparing Dispensary and Health center performances on structural quality indicated relatively low differences among the attributes assessed. Specifically, they did not show statistical significant differences except for obstetric emergencies (p < .005), sterilization (p=. 034) and overall structural quality (p=. 018). With regard to rural-urban performance on structural quality, there was no statistical significant difference on total performance. Similarly, there was no significant differences between rural and urban health facilities on other assessed attributes of structural quality (p >.05) except for sterilization in which urban facilities performed significantly higher than the rural facilities [M=41.2, SD=27.7, 61.3, SD=28.4, respectively (p= .028)]. On the other hand, marginal differences were observed on individual assessed attributes. For examples, rural facilities performed relatively higher than urban ones on privacy (41.2 and 32.0), maternal death reviews (31.4 and 30.7) and waste management (49.0 and 47.3) respectively.ConclusionGenerally facilities performed low on the structural quality indicators of maternal health services provision however; they had high performance on sterilization and emergence obstetric care.

scholarly journals “…This facility has all that is Required for Safe Baby Delivery in Case of An Emergency There is a Theater…” Exploring Experiences and Perceptions of Quality of Maternity Care in a Rural Sub-County. A Qualitative Study

2020 ◽  
Author(s):  
Jackline Akinyi Oluoch-Aridi ◽  
Francis Wafula ◽  
Gilbert O Kokwaro ◽  
Mary B Adam
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Primary Health ◽  
Delivery Services ◽  
Primary Health Facilities

Abstract Background Maternal mortality still remains a big health system challenge in Kenya. Free maternity policy resulted in an increase in Facility-based delivery. However, this has not been accompanied with a reduction in maternal mortality. This research aims at establishing women’s experiences and perceptions with regard to the quality of maternal health services received at health facilities during delivery. This contextual knowledge will assist policy makers to better understand patterns of health system utilization critical for forging strategies for reducing inequities and providing high quality maternal care.Methods Women aged between 18 and 49 who had recently delivered and were attending six-week immunization clinics were purposively selected at six different health facilities and focus group discussions were conducted with the women. The data was analyzed using thematic content analysis. Verbatim excerpts from the women were provided to illustrate the themes identified. The WHO vision for quality of care was used to assess the themes on experiences of care described by the womenResults Six themes were identified as facilitators to access maternal health services 1) Perceived quality of delivery services 2) Financial access to delivery services 3) Referrals to public tertiary health facilities 4) Social influence 5) operation times at public primary health facilities 6) Distance to the health facility. A few barriers were identified under the perceived quality of services most prominent been the mistreatment of women by night-shift nurses and the operation time at the primary health facilitiesConclusion The findings suggest that the rural women tend to prefer tertiary maternity health facility and there are a number of factors related to quality of care based on their experiences that predispose their choices. Most prominent was the availability of equipment such as theatres for obstetric complications. Another emerging issue was respectful care during maternity services. Auxiliary costs still present a challenge despite the free maternity services. Future studies need to focus on ensuring in depth contextual understanding of women’s perceptions of the experience of care with regard to patient-centered care. Understanding these aspects will help in forging strategies to reduce inequities that are leading to high maternal mortality

scholarly journals Adequacy of resources for provision of maternal health services at the primary health care level in Nnewi, Nigeria

2014 ◽  
Vol 55 (3) ◽  
pp. 235 ◽  
Author(s):  
ChinomnsoC Nnebue ◽  
UzoE Ebenebe ◽  
ProsperOU Adogu ◽  
EchenduD Adinma ◽  
ChigozieO Ifeadike ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Maternal Health Services ◽  
Care Level ◽  
Primary Health ◽  
Primary Health Care Level

scholarly journals Maternal Health Care Among Refugees and Host Communities in Northern Uganda: Access, Quality, and Discrimination

2021 ◽  
Vol 2 ◽  
Author(s):  
Siri Aas Rustad ◽  
Helga Malmin Binningsbø ◽  
Haakon Gjerløw ◽  
Francis Mwesigye ◽  
Tony Odokonyero ◽  
...  
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Services ◽  
Antenatal Care ◽  
Health Facility ◽  
Maternal Health Services ◽  
Maternal Health Care ◽  
Host Community ◽  
Northern Uganda

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value &lt; 0.05) but are 8% points more likely to give birth at a health facility (p-value &lt; 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value &lt; 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value &lt; 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.

scholarly journals Reducing Maternal Mortality: A Qualitative Study of Health Workers’ Expectation in Urban Area, Indonesia

2021 ◽  
Vol 9 (T4) ◽  
pp. 18-26
Author(s):  
Arlina Dewi ◽  
Sri Sundari ◽  
Nursetiawan Nursetiawan ◽  
Supriyatiningsih Supriyatiningsih ◽  
Dianita Sugiyo ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Maternal Mortality ◽  
Urban Area ◽  
Urban Areas ◽  
Health Workers ◽  
Maternal Health Services ◽  
Health Facilities ◽  
Integrated System

BACKGROUND: Maternal mortality is a sentinel event used globally to monitor maternal health and the overall quality of reproductive health care. Globally, maternal mortality is mostly due to direct causes; apparently, it is not limited by the setting or geographic region. However, Indonesia has failed to achieve the Millenium Development Goals (MDGs) target for maternal mortality. AIM: This study aims to explore health workers' and stakeholders' expectations in maternal health services to reduce maternal mortality in urban areas. METHODS: It is qualitative research through naturalistic, conducted in one of the regencies in Indonesia, the urban area with the highest Maternal Mortality Rate (MMR) in one province by 2019. Data were obtained in the form of information from Focus Group Discussions (FGDs). FGDs were carried out with stakeholders at the Health Service level (n=3), first-level health facilities or public health centres (n=3), and advanced health facilities or hospitals (n=7). Data analysis in this study employed software (Nvivo Release 1.0) to utilise transcripts in coding and categorising. RESULTS: The expectations that emerged from health workers' perspectives in the field were an integrated system of collaboration between health facilities, affordability of Hospital with Comprehensive Emergency Obstetric Care (CEmOC) in action for maternal-neonatal referral urgency, and the skilled health workers as a golden opportunity. CONCLUSION: Health workers’ expectations can improve the quality of maternal health services in urban areas, thereby reducing the MMR with a system of collaboration between health facilities, the affordability of maternal-neonatal emergency referral facilities, and the availability of Obstetricians who standby.

scholarly journals Quality of Health Services in the First Level Health Facilities and the Role of Quality and Cost Control Team in Lampung Province

2020 ◽  
Vol 3 (1) ◽  
pp. 8
Author(s):  
Asep Sukohar ◽  
Arli Suryawinata ◽  
Aulian Mediansyah
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Cost Control ◽  
Health Facilities ◽  
Care Providers ◽  
Primary Health ◽  
Control Team ◽  
Quality Of Health Services

Background: The National Health Insurance/Jaminan Kesehatan Nasional (JKN) program is a public health protection guarantee held by the Social Securite Management Agency/Badan Penyelenggara Jaminan Sosial Kesehatan (BPJS) to ensure that all Indonesians receive comprehensive, fair, and equitable health care benefits. The health services are provided using a tiered service system with the first stage in the First Level Health Facilities/Fasilitas Kesehatan Tingkat Pertama (FKTP) acting as a gatekeeper. In conducting these duties, they must always be maintained with good cost-efficiency to be able to provide optimal health service quality. The audit function is imposed by the Quality and Cost Control Team/Tim Kendali Mutu Kendali Biaya (TKMKB) which partners with BPJS. Until now, various efforts to improve the quality of services continue to be developed, one of which is the capitation-based service commitment/Kapitasi Berbasis Komitmen Pelayanan (KBK) payment method. Quality of health services in FKTP can be seen through the high number of FKTP that are affected by the capitation-based service commitment (FKTP KBK-K) payment. Additionally, the high number of FKTP KBK-K can also be a measure of the success of the quality and cost control program implemented by the regional TKMKB. Objective: To assess the quality of health services in FKTP and the TKMKB performance of Lampung Province. Methods: This research was a descriptive-analytic study using data from the BPJS report of Lampung Province and TKMKB in the first and second quarters of 2019. Results: There was an increase in the number of FKTP KBK-K in Lampung Province in the second quarter of 2019, not achieving the minimum contact number, with a low ratio of Prolanis Routine Participants Visiting/Rasio Peserta Prolanis Rutin Berkunjung (RPPRB) especially at the FKTP non-Primary Health Care Centers (non-Puskesmas) in Lampung Province. Conclusion: An increase in the number of FKTP KBK-K that is not accompanied by an increase in the clinical ability of primary health care providers (such as family doctors/primary care doctors) can reflect suboptimal health services in FKTP. Also, this can further serve as a benchmark that the performance of the provincial TKMKB is not yet optimal.

scholarly journals Effect of COVID-19 Pandemic on Provision of Sexual and Reproductive Health Services in Primary Health Facilities in Nigeria: a Cross-sectional Study

2021 ◽  
Author(s):  
Babatunde Adelekan ◽  
Erika Goldson ◽  
Zubaida Abubakar ◽  
Ulla Mueller ◽  
Audu Alayande ◽  
...  
Keyword(s):  
Health Care ◽  
Reproductive Health ◽  
Health Services ◽  
Sexual And Reproductive Health ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Health ◽  
Primary Health Facilities

Abstract BackgroundNigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive health, maternal and child health, and adolescent health services in primary health care facilities across the Nigerian States.MethodsThis was a cross-sectional study of 307 primary health facilities in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and service provision before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using non-parametric statistics.ResultsThe results show that a large proportion of the primary health facilities in the selected states opened for the provision of essential sexual and reproductive health and rights services during the COVID-19 pandemic lockdown. However, there was a significant reduction in clients’ utilization of services due to challenges experienced in service implementation such as stock-outs, and low demand for services by clients. Although the health facilities reported identifying cases of COVID-19, there was limited provision for primary protective equipment and other special offers that would motivate the health workers to optimize services for clients. ConclusionsWe conclude that efforts made to address these challenges by governments, non-governmental agencies, the private sector, and donor agencies working in low resource settings would reduce the health and social burden posed by COVID-19 in Nigeria.

scholarly journals The Kualitas Pelayanan Berhubungan Dengan Kepuasan Peserta Jkn Di Fasilitas Kesehatan Tingkat Pertama Provinsi Daerah Istimewa Yogyakarta

2019 ◽  
Vol 22 (3) ◽  
Author(s):  
Sri Sularsih Endartiwi ◽  
Pramukti Dian Setianingrum
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Random Sampling ◽  
Health Facilities ◽  
Cross Sectional ◽  
Participant Satisfaction ◽  
Primary Health ◽  
Quality Of Health Services ◽  
Primary Health Facilities

BPJS Health targets participant satisfaction to reach 95%, but until 2017 participant satisfaction reaches 85%. Participants who received service at the primary health facilities based on observations averaged 70%. Based on observations at the primary health facility can be seen that participant satisfaction is 70%. The objective was to evaluate the correlation between the quality services and participant satisfaction on the national health insurance at primary health facilities in the province of Yogyakarta. The type of research was quantitative descriptive with cross sectional design. The research location was primary health facilities that cooperate with BPJS Kesehatan in the Province of Yogyakarta. The study was conducted in July 2018. The number of samples in this study was 850 by proportional random sampling. Data analysis was using the Kendall Tau test. Results showed that the quality of health services both in terms of tangible, reliability, responsiveness, assurance and empathy were related to the satisfaction of BPJS Kesehatan participants in the primary health facilities. The results of bivariate analysis for each variable had a Sig. (2-tailed) 0,000 with a strong relationship. The quality of health services was related to the satisfaction of patients participating in the BPJS Kesehatan in the primary health facilities of the Province of Yogyakarta. Primary health facilities in order to maintain the quality of its health services so that patients participating in the National Health Insurance program remain satisfi ed with the services that have been provided. Abstrak BPJS Kesehatan menargetkan kepuasan peserta mencapai 95%, akan tetapi sampai tahun 2017 ini kepuasan peserta mencapai 85%. Peserta yang mendapatkan pelayanan di fasilitas kesehatan tingkat pertama berdasarkan hasil observasi di puskesmas, dokter keluarga dan klinik pratama rata-rata 70%. Berdasarkan hasil observasi di fasilitas kesehatan tingkat pertama (FKTP) yang bekerja sama dengan BPJS Kesehatan dapat diketahui bahwa kepuasan peserta sebesar 70%. Penelitian bertujuan untuk membuktikan bahwa kualitas pelayanan berhubungan dengan kepuasan peserta Jaminan Kesehatan Nasional (JKN) di Fasilitas Kesehatan Tingkat Pertama Di Provinsi Daerah Istimewa Yogyakarta. Jenis penelitian adalah deskriptif kuantitatif dengan rancangan cross sectional. Lokasi penelitian adalah FKTP yang bekerjasama dengan BPJS Kesehatan di Provinsi Daerah Istimewa Yogyakarta. Penelitian dilakukan pada bulan Juli 2018. Jumlah sampel dalam penelitian ini adalah 850 secara proportional random sampling. Analisis data dilakukan dengan menggunakan uji Kendall Tau. Kualitas pelayanan kesehatan baik dari sudut tangible, reliability, responsiveness, assurance maupun empathy berhubungan dengan kepuasan pasien peserta BPJS Kesehatan di FKTP Provinsi Daerah Istimewa Yogyakarta. Hasil analisis bivariat setiap variabel mempunyai nilai Sig. (2-tailed) 0,000 dengan hubungan yang kuat. Kualitas pelayanan kesehatan (tangible, reliability, responsiveness, assurance dan empathy) berhubungan dengan kepuasan pasien peserta BPJS Kesehatan di FKTP Provinsi Daerah Istimewa Yogyakarta. FKTP di Provinsi Daerah Istimewa Yogyakarta supaya tetap mempertahankan kualitas pelayanan kesehatannya sehingga pasien peserta program Jaminan Kesehatan Nasional (JKN) tetap merasa puas terhadap pelayanan yang sudah diberikan.

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