What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria

Abstract

User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria’s medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women’s use of services. Results demonstrate the embeddedness of women’s quality of care notions in the vast socioeconomic inequities that typify Nigeria’s particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country.

Health system governance following devolution: comparing experiences of decentralisation in Kenya and Indonesia

“… 45 Additionally, in Kenya, we found that politicians frequently gave preference to priorities deemed as popular with the electorate, such as construction of new health facilities or purchase of ambulances. 33 These were frequently referred to as ‘high vote’ priorities, meanwhile health promotion or disease prevention activities were not viewed as politically favourable. Now is an opportune time for Kenya to reflect on lessons learnt from other countries with longer experiences with devolution, such as Indonesia, in order to ensure that priorities reflect those that will promote public health, as well as curative services, which are often more politically appealing.…”

“… 19 48–50 In Kenya, we observed differences in the levels of capacity for key decision makers between counties. 33 Here the key leaders for health are the county executive committee member for health and the chief officer for health who may or may not have public health (or even health) or budgeting experience. Capacity also varied among other actors involved with decision making, including community members and local politicians to understand health comprehensively (including preventive, promotive, rehabilitative and curative services) and their role for setting health priorities.…”

“…Politicians tended to prioritise the need for an accountable rights-based approach, typically emphasising the importance of the public participation meetings to validate priorities directly with community members, while technical actors tended to emphasise the need for effective, efficient and equitable priorities. 33 …”

“…Other findings from the study carried out in Kenya, which explore the implications of changing priority-setting processes for community health and equity, have been published elsewhere. 33 …”

“…More information about the repsondents interviewed in Kenya have been presented elsewhere (see table 4, McCollum et al ). 33 Respondents were contacted in advance by via telephone or introduction by a known contact, such as their supervisor or Community Health Worker (CHW). Interviews and discussions were carried out at a location convenient for the respondents, often at their place of work for health workers or at an easily accessible community meeting point.…”