University of Heidelberg, Heidelberg, Germany.
Qual Health Res. 2012 May;22(5):619-29. doi: 10.1177/1049732311431897. Epub 2012 Jan 9.
Experience from countries that have achieved low maternal mortality suggests that access to good-quality maternity services is critical to improve maternal health. In this article we appraise the quality of antenatal care (ANC) services in a rural district of Uganda. We used a mixed methods approach, relying on a combination of semistructured interviews with both clients and providers, structured observations of provider-patient interactions, and infrastructure assessment of selected health facilities. We found several bottlenecks in health service delivery, including ineffective organization of educational sessions; selective omission of certain services; lack of explanation of important clinical and laboratory procedures; failure to link the performed procedures with preventive information; and occasional lack of respect for clients. The policy implications of these findings are discussed in relation to the need to (a) ensure an adequate supply of medical equipment and drugs, (b) enhance health workers' compliance with ANC guidelines, and (c) combine medical procedures with educational messages.
从已经实现低孕产妇死亡率的国家获得的经验表明，获得高质量的产妇保健服务对于改善产妇健康至关重要。本文评估了乌干达农村地区的产前保健服务质量。我们采用了混合方法，依靠对客户和提供者进行半结构化访谈、对提供者-患者互动进行结构观察以及对选定卫生设施进行基础设施评估相结合的方式。我们发现了卫生服务提供中的几个瓶颈，包括教育课程组织不力、选择性地省略某些服务、缺乏对重要临床和实验室程序的解释、未能将进行的程序与预防信息联系起来以及偶尔缺乏对客户的尊重。我们根据需要讨论了这些发现对政策的影响，以确保(a) 提供足够的医疗设备和药品，(b) 提高卫生工作者遵守产前保健指南的程度，以及(c) 将医疗程序与教育信息结合起来。
