Patient-experience during delivery in public health facilities in Uttar Pradesh, India

Abstract

In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women’s experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.

Results of a person-centered maternal health quality improvement intervention in Uttar Pradesh, India

“…Treatment Group Intervention (reference Control) Interaction term nurses, and that the relative importance of these staff in smaller facilities may be what makes them more patient friendly [19,28,29]. This study also confirms evidence that better PCMC is positively associated with better clinical care [10].…”

“…Problems of poor person-centered care are more prevalent in larger facilities, and are understood to be driven by the process of care provision, rather than infrastructure of the facility where care occurs [19]. Because of this, improvements require changing the norms of treatment practice, and are not easily or rapidly effected.…”

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

“…These findings align with previous research that demonstrates higher PCMC is associated with improved clinical outcomes. 8 , 12 …”

“… 4–7 Poor patient experiences are particularly common in large, public hospitals in Uttar Pradesh, reflective of poor public health infrastructure and an overburdened health system. 8 Specific intervention strategies to improve women’s experiences during maternity care are needed.…”

Self-reported Symptom Burden Among Patients Attending Public Health Care Facilities in India: Looking through ICPC-3 Lens

“…Other studies from India also shows that majority of patients' belonged to lower socioeconomic class. [14,17,25] As most people visit primary health facility for pregnancy related issues, this shows that number of encounters related to pregnancy and childbearing are part of the primary care services in a programmatic mode. Other studies from India also shows that women have more trust and better care at lower level of health facilities especially for uncomplicated pregnancies.…”