Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

Sharma, Gaurav; Mathai, Matthews; Dickson, Kim; Weeks, Andrew; Hofmeyr, G Justus; Lavender, Tina; Day, Louise; Mathews, Jiji Elizabeth; Fawcus, Sue; Simen-Kapeu, Aline; Bernis, Luc de

doi:10.1186/1471-2393-15-s2-s2

Cited by 97 publications

(135 citation statements)

References 65 publications

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“…In terms of the quality of meals served in similar context, women often have expressed dissatisfaction over the quality received in a facility which can be a significant barrier for poor households [35–40]. …”

Section: Discussionmentioning

confidence: 99%

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

Bhattacharyya

Srivastava

Saxena

et al. 2018

Global Health Action

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Background: Persistently high maternal mortality levels are a concern in developing countries. In India, monetary incentive schemes have increased institutional delivery rates appreciably, but have not been equally successful in reducing maternal mortality. Maternal outcomes are affected by quality of obstetric care and socio-cultural norms. In this light there is need to examine the quality of care provided to women delivering in institutions. Objective: This study aimed to examine pregnant women’s expectations of high-quality care in public health facilities in Uttar Pradesh, India, and to contrast this with provider’s perceptions of the same, as well as the barriers that limit their ability to provide high-quality care. Methods: A qualitative descriptive analysis was conducted on data from two studies – focus group discussions with rural women in their last trimester of pregnancy (conducted in 2014) to understand women’s experience and satisfaction with maternal care services, and in-depth interviews with care providers (conducted in 2016–17) to understand provision of person-centred care. Provider perspectives were matched with themes of women’s perspectives on quality of childbirth care in facilities. Results: Major themes of care prioritised by women included availability of doctors at the facility; availability of medicines; food; ambulance services; maintenance of cleanliness and hygiene; privacy; good and safe delivery with no complications; client-provider interaction; financial cost of care. Many women also voiced no expectation of care, indicating disillusionment from the existing system. Providers concurred with women on all themes of care except availability of doctors, as they felt that trained nurses were proficient in conducting deliveries. Conclusions: This study shows that women have clear expectations of quality care from facilities where they go to deliver. Understanding their expectations and matching them with providers’ perspectives of care is critical for efforts to improve the quality of care and thereby impact maternal outcomes.

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Section: Discussionmentioning

confidence: 99%

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

Bhattacharyya

Srivastava

Saxena

et al. 2018

Global Health Action

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“…Research increasingly points to the role that respect plays in this process (Renfrew, 2014: Sharma et al, 2015Hulton et al, 2000;Srivastava, 2015). In recent years, the relationship between quality care and maternal outcomes has become more apparent with the World Health Organisation issuing a statement on the prevention and elimination of disrespect and abuse during facility-based care (WHO, 2015).…”

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confidence: 99%

What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

Ackers

Webster

Mugahi³

et al. 2018

IJHG

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Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.

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“…High quality maternity services involves providing minimum level of care to all pregnant women and their newborn babies and a higher level of care for those who need it. 19 Planning should, therefore, consider existing geographical realities, availability of staff, drug, equipment, infrastructure, referral and transportation capacity, availability of emergency surgery, blood WUDQVIXVLRQ FDSDELOLW\ DQG DYDLODELOLW\ RI VSHFLDOL]HG care for mothers and babies. Care seeking practices, case load and case mix at maternity facilities are also important for planning purposes.…”

Section: Xdolw\ Ri )Dflolw\ %Dvhg Andduhmentioning

confidence: 99%

“…High quality maternity care require provision of timely, reliable, HTXLWDEOH HI¿FLHQW FRPSDVVLRQDWH SDWLHQWFHQWUHG care, with application of evidence based standards to ensure patient safety and health worker satisfaction. 19 Delivery of such services should also maintain sound PDQDJHULDO DQG ¿QDQFLDO SHUIRUPDQFH VWDQGDUGV DQG improve quality of existing services for women and children. 19 WHO estimates indicate that Nepal has only 6.4 doctors, nurses and midwives per 10,000 population compared to WHO critical threshold of 22.8 per 10, 000 population.…”

Section: Xdolw\ Ri )Dflolw\ %Dvhg Andduhmentioning

confidence: 99%

“…19 Delivery of such services should also maintain sound PDQDJHULDO DQG ¿QDQFLDO SHUIRUPDQFH VWDQGDUGV DQG improve quality of existing services for women and children. 19 WHO estimates indicate that Nepal has only 6.4 doctors, nurses and midwives per 10,000 population compared to WHO critical threshold of 22.8 per 10, 000 population. 20 This demonstrates the need to urgently scale up production, deployment and retention of skilled teams of health workers involved in the provision of maternity services.…”

Section: Xdolw\ Ri )Dflolw\ %Dvhg Andduhmentioning

confidence: 99%

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Beyond the Rhetoric: Maternal, Newborn and Child Survival in Nepal

Sharma

Pandey

2016

Nepal j. obstet. gynaecol.

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Nepal has performed exceptionally in improving reproductive, maternal and child health outcomes over the past two decades. In this article, we discuss these achievements and outline a vision for the future of maternal, newborn and child survival in Nepal after the era of the Millennium Development Goals. On the pathway towards quality universal health care services for all, we propose strengthening of health information systems, gradual health system reforms, improvement of existing facility based services, development of integrated service delivery models, improved technical and managerial capacity at district and facility levels. Elimination of all preventable causes of maternal, newborn and child deaths in Nepal should be our collective aspirational goal..H\ZRUGV child; maternal; Nepal; newborn; quality of care.

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Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

Cited by 97 publications

References 65 publications

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

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

What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

Beyond the Rhetoric: Maternal, Newborn and Child Survival in Nepal

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