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Ugandan health workers’ and mothers’ views and experiences of the quality of maternity care and the use of informal solutions: a qualitative study

Ugandan health workers’ and mothers’ views and experiences of the quality of maternity care and the use of informal solutions: a qualitative study
Ugandan health workers’ and mothers’ views and experiences of the quality of maternity care and the use of informal solutions: a qualitative study

Introduction Although the coverage of maternity services in some low and middle-income countries (LMIC) has greatly improved, the quality of maternity care remains poor, and maternal mortality rates are high. In this study, we describe the meaning and determinants of maternity care quality from the perspective of health workers and mothers in Uganda, the informal solutions used by health workers to manage their daily challenges, and we suggest ways in which maternal care quality can be improved. Methods We conducted a qualitative study in the Mpigi and Rukungiri districts of Uganda. Twenty-eight health workers based at selected health centres participated in structured interviews. Thirty-six mothers, half of whom had delivered at health facilities, participated in focus group discussions. Data were analysed thematically, and informed by the WHO framework on quality of care for maternal and newborn health and by Lipsky’s street level bureaucracy concept. Results According to health workers, knowledge of clinical standards and processes, timeliness, and women’s choice during labour, as well as resources, physical infrastructure; collaboration with mothers, professionals and community health workers; were important aspects of good quality care. Mothers’ perceptions of good quality care were largely similar to health workers’ views, though mothers were more concerned about health workers’ interaction skills. Structural challenges sometimes led health workers to develop informal solutions such as asking mothers to purchase their own supplies with variable implications on the quality of care. While several of these informal solutions were useful in addressing bottlenecks in the health system, they sometimes placed additional burdens and personal costs on health workers, created mistrust, inequity in care and negative experiences among mothers who could not afford the extra costs. Conclusions Health system structural factors; including technical, interpersonal, resource and infrastructural factors; impede the provision and experience of good quality maternity care at health centres in Uganda. Improving the quality of care will require strategies that address these core problems in the health system structure. Such structural reforms will require political support to commit resources, skilful management and leadership that seek to change organisational behaviour and build trust through good quality, woman-centred maternity care.

1932-6203
1-20
Munabi-Babigumira, Susan
d0e95f36-5220-4942-a505-cf2fd86cbe44
Glenton, Claire
372189df-d108-460d-a258-6379b2fc638e
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Nabudere, Harriet
250c8b27-5a83-4dd0-b690-4bd91b5842e6
Munabi-Babigumira, Susan
d0e95f36-5220-4942-a505-cf2fd86cbe44
Glenton, Claire
372189df-d108-460d-a258-6379b2fc638e
Willcox, Merlin
dad5b622-9ac2-417d-9b2e-aad41b64ffea
Nabudere, Harriet
250c8b27-5a83-4dd0-b690-4bd91b5842e6

Munabi-Babigumira, Susan, Glenton, Claire, Willcox, Merlin and Nabudere, Harriet (2019) Ugandan health workers’ and mothers’ views and experiences of the quality of maternity care and the use of informal solutions: a qualitative study. PLoS ONE, 14 (3), 1-20. (doi:10.1371/journal.pone.0213511).

Record type: Article

Abstract

Introduction Although the coverage of maternity services in some low and middle-income countries (LMIC) has greatly improved, the quality of maternity care remains poor, and maternal mortality rates are high. In this study, we describe the meaning and determinants of maternity care quality from the perspective of health workers and mothers in Uganda, the informal solutions used by health workers to manage their daily challenges, and we suggest ways in which maternal care quality can be improved. Methods We conducted a qualitative study in the Mpigi and Rukungiri districts of Uganda. Twenty-eight health workers based at selected health centres participated in structured interviews. Thirty-six mothers, half of whom had delivered at health facilities, participated in focus group discussions. Data were analysed thematically, and informed by the WHO framework on quality of care for maternal and newborn health and by Lipsky’s street level bureaucracy concept. Results According to health workers, knowledge of clinical standards and processes, timeliness, and women’s choice during labour, as well as resources, physical infrastructure; collaboration with mothers, professionals and community health workers; were important aspects of good quality care. Mothers’ perceptions of good quality care were largely similar to health workers’ views, though mothers were more concerned about health workers’ interaction skills. Structural challenges sometimes led health workers to develop informal solutions such as asking mothers to purchase their own supplies with variable implications on the quality of care. While several of these informal solutions were useful in addressing bottlenecks in the health system, they sometimes placed additional burdens and personal costs on health workers, created mistrust, inequity in care and negative experiences among mothers who could not afford the extra costs. Conclusions Health system structural factors; including technical, interpersonal, resource and infrastructural factors; impede the provision and experience of good quality maternity care at health centres in Uganda. Improving the quality of care will require strategies that address these core problems in the health system structure. Such structural reforms will require political support to commit resources, skilful management and leadership that seek to change organisational behaviour and build trust through good quality, woman-centred maternity care.

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Accepted/In Press date: 22 February 2019
Published date: 11 March 2019

Identifiers

Local EPrints ID: 429628
URI: https://eprints.soton.ac.uk/id/eprint/429628
ISSN: 1932-6203
PURE UUID: efdfbe63-b1c0-49c1-921b-7bc842f399fc
ORCID for Merlin Willcox: ORCID iD orcid.org/0000-0002-5227-3444

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Date deposited: 02 Apr 2019 16:30
Last modified: 03 Apr 2019 00:25

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Contributors

Author: Susan Munabi-Babigumira
Author: Claire Glenton
Author: Merlin Willcox ORCID iD
Author: Harriet Nabudere

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