Sanogo N'doh Ashken, Fantaye Arone Wondwossen, Yaya Sanni
Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120, University Private, Ottawa, ON, K1N 6N5, Canada.
BMC Health Serv Res. 2020 May 30;20(1):483. doi: 10.1186/s12913-020-05310-6.
Access to affordable and adequate healthcare in a health system determines the universal health coverage achievement for all residents in a country. Achieving access to healthcare requires the availability of a financing system that ensures access to and provision of adequate care, regardless of the ability to pay. In sub-Saharan Africa, accessibility, use and coverage of prenatal visits are very low and poor, which reduces the quality of care. This paper explored the impact of a social health insurance scheme on the quality of antenatal care in Gabon.
This qualitative study involved the analysis of data collected from semi-structured interviews and non-participant observations to assess the quality of antenatal care. The study elicited perceptions on the demand side (pregnant women) and the supply side (health professionals) in health facilities. Fifteen semi-structured interviews were conducted with pregnant women (aged between 15 and 49) and 5 with health professionals, who each had a seniority of at least 10 years, at different levels of care. Nine non-participant observations were also conducted. Coded transcripts were reviewed and analyzed using the Canadian Institute for Public Administration of Citizen-Centered Services model as an analytical guide.
On the demand side, women were generally satisfied with the prenatal services they receive in health facilities. However, complaints were made about the rudeness of some nurses, the high price of the delivery kit (50,000 XAF), and the fact that some essential medicines for maternity are not covered. On the supply side, participants agreed that compulsory health insurance is important in providing antenatal care access to those who need it the most. However, some problems remain. The participants outlined some logistical problems and a lack of medical equipment, including the stock of drugs, disinfectants, and the absence of clean water.
Understanding the perceptions of pregnant women and health professionals regarding the quality of antenatal care can help to inform refinements to methods through which the services can be better provided. In addition, the study findings are vital to increasing the use of care, as well as combating high maternal mortality rates. Compulsory health insurance has improved the accessibility and utilization of healthcare services and has contributed to improved quality of care.
卫生系统中能否获得负担得起且足够的医疗保健决定了一个国家所有居民的全民健康覆盖成就。实现医疗保健可及性需要有一个融资系统，以确保无论支付能力如何，都能获得并提供足够的医疗服务。在撒哈拉以南非洲，产前检查的可及性、利用率和覆盖率都非常低且差，这降低了医疗服务质量。本文探讨了一项社会医疗保险计划对加蓬产前保健质量的影响。
这项定性研究涉及对通过半结构化访谈和非参与观察收集的数据进行分析，以评估产前保健质量。该研究引发了对卫生设施中需求方（孕妇）和供应方（卫生专业人员）的看法。对15名年龄在15至49岁之间的孕妇进行了半结构化访谈，并对5名具有至少10年资历的不同护理级别的卫生专业人员进行了访谈。还进行了9次非参与观察。使用加拿大公共管理公民中心服务研究所模型作为分析指南，对编码后的笔录进行审查和分析。
在需求方，女性总体上对她们在卫生设施中接受的产前服务感到满意。然而，她们抱怨一些护士态度粗鲁、分娩套件价格高昂（50,000非洲法郎），以及一些产妇必需药品未涵盖在内。在供应方，参与者一致认为强制医疗保险对于为最需要的人提供产前保健可及性很重要。然而，仍存在一些问题。参与者概述了一些后勤问题以及医疗设备短缺，包括药品库存、消毒剂，以及没有清洁水。
了解孕妇和卫生专业人员对产前保健质量的看法有助于为改进服务提供方式提供参考。此外，研究结果对于增加医疗服务的使用以及降低孕产妇高死亡率至关重要。强制医疗保险提高了医疗服务的可及性和利用率，并有助于提高医疗服务质量。
