“Neither we are satisfied nor they”-users and provider’s perspective: a qualitative study of maternity care in secondary level public health facilities, Uttar Pradesh, India

Abstract

BackgroundQuality of care provided during childbirth is a critical determinant of preventing maternal mortality and morbidity. In the studies available, quality has been assessed either from the users’ perspective or the providers’. The current study tries to bring both perspectives together to identify common key focus areas for quality improvement.This study aims to assess the users’ (recently delivered women) and care providers’ perceptions of care to understand the common challenges affecting provision of quality maternity care in public health facilities in India.MethodsA qualitative design comprising of in-depth interviews of 24 recently delivered women from secondary care facilities and 16 health care providers in Uttar Pradesh, India. The data were analysed thematically to assess users’ and providers’ perspectives on the common themes.ResultsThe common challenges experienced regarding provision of care were inadequate physical infrastructure, irregular supply of water, electricity, shortage of medicines, supplies, and gynaecologist and anaesthetist to manage complications, difficulty in maintaining privacy and lack of skill for post-delivery counselling. However, physical access, cleanliness, interpersonal behaviour, information sharing and out-of-pocket expenditure were concerns for only users. Similarly, providers raised poor management of referral cases, shortage of staff, non-functioning of blood bank, lack of incentives for work as their concerns.DiscussionThe study identified the common themes of care from both the perspectives, which have been foundrelevant in terms of challenges identified in many developing countries including India. The study framework identified new themes like management of emergencies in complicated cases, privacy and cost of care which both the group felt is relevant in the context of providing quality care during childbirth in low resource setting. The key challenges identified by both the groups can be prioritized, when developing quality improvement program in the health facilities. The identified components of care can match the supply with the demand for care and make the services truly responsive to user needs.ConclusionThe study highlights infrastructure, human resources, supplies and medicine as priority areas of quality improvement in the facility as perceived by both users and providers, nevertheless the interpersonal aspect of care primarily reported by the users must also not be ignored.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1077-8) contains supplementary material, which is available to authorized users.

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

“…Space constrained labour-rooms and obstructions caused by the use of curtain in attending to multiple women simultaneously have been cited as potential reasons that providers do not use curtains for privacy [11,52–54]. Facility cleanliness in terms of clean linen in the wards, with frequent cleaning of the wards and toilets was a significant determinant of women’s overall satisfaction of services, which often are irregular and disorganised [55–59].…”

“…Perceptions surrounding the quality of care that will be received in a facility impact a woman’s initial decision to deliver in a facility, in addition to whether she will access institutional delivery for subsequent births [6,7,10]. Although women in LMICs have reported that high-quality interpersonal interactions are directly related to satisfaction with care, research suggests that providers may consider elements such as respect, privacy, dignity and information-sharing to be less critical components of care that require immediate attention [11]. …”

Conceptualising the effect of access to electricity on health in low- and middle-income countries: A systematic review

“…The supply of health services was also a commonly studied outcome and the majority of the included reliability articles focused on the effects of electricity interruptions on health service delivery or healthcare quality, with most finding a negative association. In a qualitative study assessing users' and providers' perceptions of maternity care in India, for instance, Bhattacharyya, Issac, Rajbangshi, Srivastava, and Avan (2015) identified poor electricity reliability as a common challenge to delivering high quality care in Indian health facilities (Bhattacharyya et al, 2015). Indeed both health care users and providers noted the importance of a regular supply of electricity, with one provider remarking that a lack of fuel funding constrained the use of the generators, such that deliveries sometimes had to be conducted by candle light (Bhattacharyya et al, 2015).…”

Satisfaction with childbirth services provided in public health facilities: results from a cross- sectional survey among postnatal women in Chhattisgarh, India

“…Working women tend to have lower satisfaction levels with childbirth services compared with homemakers [16]. Having a fear of childbirth and/or postnatal depressive symptoms has a negative and compounding association with satisfaction [17–19]. …”

“…Labour rooms have become crowded and understaffed and face shortages of equipment and material [17,40] and the documentation processes around childbirth have been described to be ‘too much to do concurrently with actual care provision’, with care providers relying on verbal communication rather than maintaining written documentation of decision-making around childbirth [17,41]. Qualitative studies exploring Indian women’s experiences and opinions on giving birth at a health facility reveal that they are not fully satisfied with their childbirths, primarily due to the long waiting time before they meet a healthcare provider, having few opportunities to communicate with providers, not being involved in decision-making, and having stern care providers [17,35,42,43]; however, they settle for childbirth services perceived as ‘essential’ for safe childbirth rather than ‘desirable’ for a pleasant experience [17,44,45]. …”