Miteniece Elina, Pavlova Milena, Shengelia Lela, Rechel Bernd, Groot Wim
Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
National Center for Disease Control and Public Health (NCDC) Georgia, Asatiani street 9, 0177, Tbilisi, Georgia.
BMC Health Serv Res. 2018 Aug 13;18(1):631. doi: 10.1186/s12913-018-3432-z.
The maternal health outcomes in Georgia are linked to shortcomings in healthcare such as inequities in access to adequate maternal care. Due to the macro-level, quantitative approach applied in most previous studies, little is known about the underlying reasons that influence maternal care and care-seeking behaviour of pregnant women.
This qualitative study explores the stakeholders' perspectives on access to adequate maternal care in Georgia. Focus-group discussions are conducted with mothers who gave birth within in the past four years and in-depth interviews are conducted with decision-makers and health professionals in the field. Five access-related aspects are studied: availability, appropriateness, affordability, approachability and acceptability of maternal care. The method of direct content analysis is applied.
Results indicate problems with maternal care standards, inequalities across population groups and drawbacks in maternal care financing. This includes gaps in clinical quality and staff skills, as well as poor communication between women and health professionals. Geographical barriers to adequate maternal care exist in rural and mountainous areas due to the weak infrastructure (poor roads and weak transportation), in addition to financial hardships. Despite improvements in the coverage of maternal care, affordability remains an access barrier. Poorer population groups are financially unprotected from the high out-of-pocket payments for maternal care services.
These findings imply that micro-level indicators, such as disrespectful behaviour of health professionals and affordability of care, should be taken into account when assessing maternal care provision in Georgia. It should complement the existing macro-level indicators for a comprehensive evaluation of maternal care.
格鲁吉亚的孕产妇健康结果与医疗保健方面的缺陷有关，例如在获得充分孕产妇护理方面存在不公平现象。由于大多数先前研究采用宏观层面的定量方法，对于影响孕产妇护理及孕妇就医行为的潜在原因知之甚少。
本定性研究探讨了利益相关者对格鲁吉亚获得充分孕产妇护理的看法。对过去四年内分娩的母亲进行了焦点小组讨论，并对该领域的决策者和卫生专业人员进行了深入访谈。研究了与获得护理相关的五个方面：孕产妇护理的可及性、适宜性、可负担性、易接近性和可接受性。采用直接内容分析法。
结果表明孕产妇护理标准存在问题、不同人群之间存在不平等以及孕产妇护理融资存在缺陷。这包括临床质量和工作人员技能方面的差距，以及妇女与卫生专业人员之间沟通不畅。除了经济困难外，由于基础设施薄弱（道路状况差和交通不便），农村和山区在获得充分孕产妇护理方面存在地理障碍。尽管孕产妇护理覆盖率有所提高，但可负担性仍然是一个获得护理的障碍。较贫困人群在经济上无法抵御孕产妇护理服务高额的自付费用。
这些发现表明，在评估格鲁吉亚的孕产妇护理提供情况时，应考虑微观层面的指标，如卫生专业人员的不尊重行为和护理的可负担性。它应补充现有的宏观层面指标，以全面评估孕产妇护理。
