Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.
University Clinic, Sunyani Technical University, Sunyani, Ghana.
BMC Health Serv Res. 2020 Oct 1;20(1):911. doi: 10.1186/s12913-020-05755-9.
The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA.
We employed the Arskey and O'Malley's framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies.
Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system.
This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.
全球旨在通过消除所有形式的财务障碍来实现全民健康覆盖，以改善医疗保健的可及性，并在 2030 年前降低母婴死亡率。尽管一些撒哈拉以南非洲（SSA）国家已经采取免费产妇保健措施作为实现这一目标的主要干预措施，但人们对医疗质量的看法可能会影响利用和产妇健康结果。我们系统地查阅了文献，并描述了 SSA 免费保健融资政策下产妇对护理质量看法的证据。
我们采用 Arskey 和 O'Malley 的框架来指导本次范围综述。我们在没有时间限制的情况下，于 2019 年 5 月 19 日之前，在 PubMed、Google Scholar、Web of Science、Science Direct 和 CINAHL 中使用关键词、布尔术语和医学主题词的组合搜索了相关的已发表文章。我们纳入了涉及孕妇/产后母亲、免费产妇护理政策、护理质量，并在 SSA 国家进行的主要研究。两名评审员根据纳入和排除标准，在摘要和全文筛选阶段独立筛选文章。所有相关数据均被提取并组织成主题，并以叙述的方式报告结果摘要。使用最近版本的混合方法评估工具来评估纳入研究的方法学质量。
在 390 篇研究中，有 13 篇研究证明了免费产妇保健和客户感知的护理质量。所有 13 项研究均在 7 个不同的国家进行。我们发现，加纳和肯尼亚各有 3 项研究，布基纳法索和尼日利亚各有 2 项研究，尼日尔、塞拉利昂和坦桑尼亚各有 1 项研究。在纳入的 13 项研究中，有 8 项研究表明，孕妇认为免费产妇保健政策下的医疗服务质量较差。造成这种服务质量差的原因有：长时间等待、提供者态度不佳、基本药物供应不足且缺乏饮用水、熟练助产士分布不均、自费支付和薄弱的患者投诉系统。
本研究表明，在 SSA 的免费护理政策下，对产妇对护理质量的看法进行研究的文献很少。考虑到母亲对护理质量的看法可能对未来卫生服务的利用产生影响，因此需要在家庭、社区和医疗设施层面进行进一步研究，以发现和解决所有隐藏的护理质量挑战，改善产妇保健服务，实现母婴健康方面的可持续发展目标。
