Health Workers and Users’ Perspective of Quality of Maternal Health Care in Health Facilities in Somali Region of Ethiopia: A Qualitative Study

Abstract

Aims: In spite of progress made in reducing maternal mortality, there remains a high burden of deaths related to the quality of care mothers receive in low- and middle-income countries. Ethiopia health sector transformation plan focused on improving equity and quality of health care at all levels of the system. The study explored health workers and users’ perspectives of quality of maternal health care in health facilities in Somali Region.
 Study Design: This was a descriptive study.
 Place and Duration of Study: Somali Region of Ethiopia in October 2021.
 Methodology: A qualitative, descriptive design conducted in four project woredas in the region selected using multistage sampling technique. The participants were 23 health workers (health facility providers and health administrators) and 20 pregnant and lactating women purposefully identified and recruited based on their knowledge of maternal health care delivery in the study sites. The WHO framework for quality of maternal and newborn health care was used for the in-depth interviews and focus group discussions.
 Results: The health workers had knowledge about what constitutes quality health care which include availability of adequate human resources, drugs and equipment, patient satisfaction and improved service utilization, effective referral services and use of clinical guidelines. Compassionate, respectful and caring health workforce was considered by the users as a major component of quality of care. Three major barriers to providing quality of care in the health facilities were human resource (shortage and high turnover of health workers, poor motivation, poor use of clinical guidelines), management constraints (limited training, and supervision, weak ambulance services for referral) and material constraints (shortage of medical supplies/drugs, equipment and infrastructure).
 Conclusion: To ensure quality of maternal and newborn care, the identified barriers should be addressed focusing on the key priority areas.

Non-financial Incentives for Retention of Health Extension Workers in Somali Region of Ethiopia: A Discrete Choice Experiment

“…A study done in the region on the quality of care reported that most of the health workers expressed their frustration in being able to provide the needed quality of care because their skills and competencies are limited in view of limited access to regular inservice training, supervision and management support by the regional and woreda authorities. 17 The finding on the supportive management as incentive for retention is similar to findings in many studies among various cadres of health workers that report strong leadership and supportive management as important non-financial incentives. [18][19][20] A study in Ghana among health workers in a district hospital reported that among the 4 factor model of non-financial incentives, leadership skill and supervision was ranked first predictor of motivation and retention.…”

“…A study done in the region on the quality of care reported that most of the health workers expressed their frustration in being able to provide the needed quality of care because their skills and competencies are limited in view of limited access to regular in-service training, supervision and management support by the regional and woreda authorities. 17 …”