Ansu-Mensah Monica, Danquah Frederick Inkum, Bawontuo Vitalis, Ansu-Mensah Peter, Mohammed Tahiru, Udoh Roseline H, Kuupiel Desmond
Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana.
The University Clinic, Sunyani Technical University, Sunyani, Ghana.
BMC Pregnancy Childbirth. 2021 Mar 19;21(1):220. doi: 10.1186/s12884-021-03701-z.
BACKGROUND: Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers' and providers' perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers' and providers' perspectives of free maternal healthcare and the quality of care in SSA. METHODS: We used Askey and O'Malley's framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. RESULTS: In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers' and providers' perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. CONCLUSION: This study established evidence of existing literature on the quality of care based on healthcare providers' and managers' perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.
背景：免费孕产妇医疗保健筹资计划在撒哈拉以南非洲（SSA）的产前护理中为客户提供的服务质量方面发挥着重要作用。然而，医疗保健管理人员和提供者对医疗保健筹资计划的看法可能会影响护理质量。本范围综述梳理了关于撒哈拉以南非洲地区管理人员和提供者对免费孕产妇医疗保健的看法以及护理质量的证据。 方法：我们以阿斯凯和奥马利的框架为指导进行本综述。为解决研究问题，我们检索了PubMed、通过EBSCOhost检索的CINAHL、ScienceDirect、科学网和谷歌学术，检索时间截至2019年5月，无日期限制，使用关键词、布尔术语和医学主题词来检索相关文章。两位审稿人独立进行摘要和全文筛选，以纳入和排除标准为指导。提取所有重要数据，整理成主题，并以叙述方式报告研究结果总结。 结果：390篇文章中共有15篇符合纳入标准。这15项研究在9个国家进行。即加纳（4项）、肯尼亚（3项）、尼日利亚（2项）、布基纳法索（1项）、布隆迪（1项）、尼日尔（1项）、塞拉利昂（1项）、坦桑尼亚（1项）和乌干达（1项）。在纳入的15项研究中，14项从管理人员和提供者的角度报告了孕产妇医疗保健质量较差。导致孕产妇医疗保健质量差这一看法的因素包括：资金报销延迟、提供者工作量大、缺乏基本药物和医疗用品缺货、缺乏政策界定、自付费用以及工作人员分配不均。 结论：本研究基于医疗保健提供者和管理人员的观点，确立了现有文献中关于护理质量的证据，尽管非常有限。本研究表明，医疗保健提供者和管理人员认为免费筹资政策下的孕产妇医疗保健质量较差。尽管如此，免费孕产妇护理政策对于实现全民健康非常必要，必须鼓励所有维持和改善该政策下护理质量的努力。因此，需要更多研究来更好地理解他们所认为的护理质量差对孕产妇健康结果的影响。
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