OF
CONTENTS
Content Page
Title page i
Certification ii
Dedication iii
Acknowledgements
Abstract v
Table of Contents
vi
List of Tables
viii
List of Figures
ix
CHAPTER
ONE: INTRODUCTION
- Background to the Study 1
- Statement of the Problem 3
- Objective of the Study 4
- Research Questions 5
- Hypotheses 5
- Scope of the Study 5
- Significance of the Study 5
- Operational Definition of Terms 6
CHAPTER
TWO: REVIEW OF LITERATURE
2.0. Introduction 8
2.1. Maternal and Child Health Service 8
2.2. Incidence of Maternal
and Child Mortality 10
2.3. Maternal Mortality in Nigeria 11
2.4. Availability of Skilled Personnel for MCH Services in Nigeria 12
2.5. Health Facilities Assessment 18
2.6. Quality of Maternal and Child Health Services 19
2.7. Client Satisfaction with Maternal and Child
Health Services 23
2.8. Factor that Determine Client Satisfaction 27
2.9. Conceptual Model 29
CHAPTER THREE: METHODOLOGY
3.0 Introduction 33
3.1 Research Design 33
3.2 Population 33
3.3 Sample size and sampling Technique 33
3.4 Instrument for Data Collection 36
3.5 Validity and reliability of the Instruments 36
3.6 Data Collection Procedure 37
3.7 Method of Data Analysis 37
3.8 Ethical Consideration
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND DISCUSSION
OF FINDINGS
4.0 Introduction 39
4.1 Result Presentation 39
4.2. Data Analysis 39
4.3. Discussion of Findings 56
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 62
5.2 Conclusion 63
5.3 Recommendations 63
5.4 Limitation of the Study 64
5.5 Suggestion
for Further Studied 64
REFERENCES 65
APPENDICES 73
LIST OF TABLES
Table Page
1:
Demographic data of the Participants (Structure and Process) 39
2:
Demographic data of Respondents on client satisfaction (Outcome) 41
3:
Structure of MCH in Primary and Secondary health facilities 43
4: Process of MCH in Primary and Secondary health facilities 47
5
Client’s satisfaction with MCH services in Primary and Secondaryhealth
facilities 50
6:
Categories and Number of personnel for MCH services in health facilities 53
7:
T-Test for the structure of MCH in Primary and Secondary health facilities 54
8:
T-Test for the process of MCH in Primary and Secondary health facilities. 54
9:
T-Test for the client satisfaction of MCH in Primary and Secondary facilities 55
LIST
OF FIGURES
Figure Page
1:
Conceptual Framework for quality of MCH services
31
2:
Bar chart showing the percentage of Personnel with Training in MCH services 44
3. Bar Chart showing Physical facilities that are available and in good working conditions in percentages 45
4. Bar chart showing the percentage distribution of Maternal and Child health care services (Process) rendered by selected heath facilities 48
5.
Bar charts showing clients satisfaction with MCH services in Health facilities in percentages 51
CHAPTER
ONE
INTRODUCTION
1.1
Background to the Study
The quality of care received
during pregnancy and the place of delivery are great determinants of maternal
and child morbidity and mortality. Improving and sustaining the quality of care
in healthcare institutions has been an area of concerns and recurrent issue
over the year. The client’s expression of satisfaction with the quality of
health care can provide insightful feedback for healthcare providers, managers
and policy makers to direct quality improvement efforts in a right direction
(Beattie, Lauder, Atherton, Murphy 2014). Quality assessment is an important
aspect of quality assurance which focus on identification of barriers and
challenges in a system and not just bad performers (Tobin-West and Anastasia
2016).
On yearly basis, an average of 289 000 women
reportedly die as a result of complications associated with pregnancy and child
delivery. Also, about 6.6 million under 5 year old children death resulted from
complications in the neonatal period and early childhood illness (World Health
Organization (WHO), 2013). These deaths are preventable with provision of
quality and optimal maternal and child health care in health facilities.
Although
remarkable achievement has been recorded in some areas of reproductive, women
and children health interventions over the years, little progress has been
recorded in efforts directed towards improvement of maternal and child health
outcomes due to a wide gap between the scope and the quality of health care
provided in facilities (WHO, UNICEF, 2014). Quality of care is considered very
important in the international initiatives and Global Strategy for Every Woman
and Child.
Yearly,
about 500,000 women and girls die due to complications arising from pregnancy,
labour and or the 6 weeks post- delivery. Majority of these mortality happen in
less developed countries (United Nations Millennium Development Goals 2009),
making the process of delivery one
of the most dreaded journeys for women of child bearing age. This is worrying
some as statistical findings showed that the extent of maternal mortality in
low and middle income countries resulting from pregnancy and childbirth is on
the increase (United Nations Children
Fund (UNICEF) Nigeria, 2014).
Similarly, the risk of death from conception and
child delivery in Nigeria is ratio 1 to 13.On
daily basis, about 2,300 under-five year old children and 145 women in their
reproductive years die in Nigeria. With these figures, Nigeria was rated the
second largest country contributing to the under–five and maternal death in the world. Many of these deaths could be prevented but for
Nigeria’s coverage and quality of health care services that continue to fall
short of expectation for women and children. According to United Nations
International Children Fund (UNICEF), Nigeria (2014) report, less than 20% of
health facilities in the country provide emergency obstetric care (Eoc) and
about 35% of deliveries are taken by health professionals.
A national health policy formulated for
Nigerians in 1988 was targeted at achieving quality health for all. Emerging health issues and the realities to
focus on new trends prompted the review of the policy over the years to improve
quality in health care services across the nation (Nigeria Demographic Survey,
2013). A health delivery system targeting
reduction in maternal morbidity and mortality must ensure quality reproductive
care for this group of people (United States Agency for International
Development (USAID), 2013).
Donabedian model was developed in 1966 for assessing healthcare services and to evaluate quality of health care. The model was revised in 1988 and provides information about quality of care using three categories which are structure, process, and outcomes. Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process involves the transactions between patients and healthcare professionals throughout the delivery of healthcare. Outcomes refers to the effects of healthcare on the health status of client and client satisfaction. Since then other quality of care frameworks, including the World Health Organization (WHO) recommended Quality of Care Framework and the Bamako Initiative etc. have been developed but the Donabedian Model continues to be the dominant framework for assessing the quality of health care up till today (Lawson and Yazdany 2012). In 2013, World Health Organization and Partnership for Maternal, Newborn, and Child Health used Donabedian model to develop key indicators for quality in Maternal, Newborn, and Child Health care.
Maternal
health care is the care a woman receives during conception, delivery, and post-
delivery, it is crucial for the survival and well-being of mother and child. It
comprises a broad range of services like family planning, prenatal,
intrapartum, and postpartum care with the focus of minimizing maternal death
and disability (Franny, 2013).
Improving the quality of obstetric care in
facilities has recently been identified as a neglected and essential approach
to reducing maternal deaths and enabling developing countries to achieve
Sustainable Development Goal 3 (SDG 3) which is good health and well- being
especially for women (Van den Broek and Graham 2009). Postpartum hemorrhage is
the most frequent cause of maternal deaths globally and in developing
countries, accounting for 25% of maternal deaths. Next are hypertensive
disorders in pregnancy (PE/E) at 15%, sepsis (8%) and obstructed labor (7%).2
Effective interventions exist for screening, preventing and treating obstetric
and newborn complications, and they can be readily provided by skilled
providers in facilities. However, achieving both high quality and coverage of
these interventions is essential in order to reduce maternal and newborn deaths
globally. International evidence suggests that the most important factor in
reducing maternal and early neonatal mortality is the attendance of a skilled
birth provider and provision of quality care (USAID/MCHIP 2013).
According
to Kana, Doctor, Peleteiro, Lunet and Barros (2015), poor maternal and child
health indicators have been a recurrent issue in Nigeria since the 1990s, and
many interventions have been instituted to reverse the trend and ensure that
Nigeria provides quality maternal and child health care.
However,
various intervention reports have documented mixed findings of the successes
and challenges as well as threats to the attainment of quality maternal and
child health care in Nigeria. It has been observed that Nigeria is lagging
behind in meeting MDG 4 and according to the United Nations mortality
estimates, Nigeria has only achieved an average of 1.2% annual reduction in
under-five mortality since 1990. And in order to meet MDG 4, Nigeria needed to
have achieved an annual reduction rate of 10% in the five years leading to 2015
(Rajaratnam , Marcus , Flaxman , Wang , Levin-Rector , Dwyer , et al 2010).
Therefore,
improving and ensuring quality of health care services in health facilities,
developing strategies for quality serve as an integral component of scaling up
interventions to improve health outcomes of mothers, newborns and children is
of utmost importance (WHO, 2013).
1.2 Statement of the Problem
The
quality of care received during pregnancy and the place of delivery are great
determinants of maternal and child morbidity and mortality (United States
Agency for International Development (USAID), 2013).Worldwide significant
number of women and girls yearly (almost half a million) die as a result of
complications during conception, delivery or 6 weeks post childbirth. Majority
of these deaths happen in underdeveloped nations (United Nations Millennium
Development Goals, 2009). The risk of death from conception and delivery is in
Nigeria is 1 in 13, many of these deaths could have been averted with good
coverage and quality maternal and child health care (United Nations
International Children Fund (UNICEF), 2014).
Increased
mothers and newborn death and morbidity has been linked to poor quality of
healthcare services (USAID, 2013), and has been evident by increased death
rates that inadequate availability of reproductive health services is an
important challenge in Nigeria (WHO Nigeria, 2014). Although progress has been
made in increasing the coverage of several key reproductive, maternal, newborn
and child health interventions over the past two decades, there has been
limited progress in improving maternal and paediatric outcomes because of a
major gap between coverage and the quality of care provided in health
facilities (WHO, UNICEF, 2014).
Also,
it has been observed from clinical practice that there are still many cases of
preventable pregnancy and delivery complications reporting in the teaching
hospital in Ile-Ife on daily bases in spite of many healthcare facilities in
the area. Improving the quality of facility-based health care services and
making quality an integral component of scaling up interventions to improve
health outcomes of mothers, newborns and children is of utmost importance (WHO,
2013).
Hence,
the need to evaluate the maternal and child healthcare services in healthcare
facilities in Ile-Ife for quality care to achieve Sustainable Development Goal
3 (SDG 3) which is good health and well-being.
1.3 Objective of the Study
The
main objective of this study is to evaluate the Quality of Maternal and Child
Healthcare Services in selected Healthcare Facilities Ile-Ife utilizing
Donabedian model for Quality care
The
specific objectives are to:
UTILIZATION OF DONABEDIAN MODEL IN EVALUATION OF MATERNAL AND CHILD HEALTHCARE QUALITY SERVICE IN SELECTED HEALTH CARE FACILITIES IN ILE-IFE
