Beyond utilization: measuring effective coverage of obstetric care along the quality cascade.
Int J Qual Health Care
; 29(1): 104-110, 2017 Feb 01.
Article
en En
| MEDLINE
| ID: mdl-27920246
ABSTRACT
OBJECTIVE:
To determine the effective coverage of obstetric care in a rural Tanzanian region and to assess differences in effective coverage by wealth.DESIGN:
Cross-sectional structured interviews.SETTING:
Pwani Region, Tanzania.PARTICIPANTS:
The study includes 24 rural, government-managed, primary healthcare clinics and their catchment populations. From January-April 2016, we conducted a household survey of a census of women with recent deliveries, health worker knowledge surveys and facility audits. MAIN OUTCOMEMEASURES:
We explored the proportion of women receiving quality care through the cascade and conducted an equity analysis by wealth.RESULTS:
In total, 2,910 of 3,564 women (81.6%) reported delivering their most recent child in a health facility, 1,096 of whom delivered in a study facility. Using a minimum threshold of quality, the effective coverage of obstetric care was 25%. Quality was lowest in the emergency care dimensions, with the average score on the provider knowledge tests at 47% and the average provision of basic emergency obstetric services below 50%. The wealthiest 20% of women were 4.1 times as likely to deliver in facilities offering at least the minimum threshold of quality care through the cascade compared to the poorest 80% of women (95% confidence interval 1.5-11.3).CONCLUSIONS:
Effective coverage of delivery care is very low, particularly among poorer women. Health worker knowledge caused the sharpest decline in effective coverage. Measures of effective coverage are a better performance measure of under-resourced health systems than utilization. Equity analyses can further identify important discrepancies in quality across socio-economic levels. TRIAL REGISTRATION ISRCTN 17107760.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Calidad de la Atención de Salud
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Parto Obstétrico
Tipo de estudio:
Observational_studies
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Prevalence_studies
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Límite:
Female
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Humans
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Newborn
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Pregnancy
País/Región como asunto:
Africa
Idioma:
En
Año:
2017
Tipo del documento:
Article