CHAPTER ONE
INTRODUCTION
BACKGROUND OF THE STUDY
The quality of prenatal care and the location of delivery are important factors in mother and infant morbidity and mortality. Over the past year, improving and maintaining the quality of care in healthcare institutions has been a source of concern and a recurring issue. Client satisfaction with the quality of health treatment can provide valuable feedback to healthcare providers, managers, and policymakers, allowing them to focus quality improvement efforts in the proper direction (Beattie, Lauder, Atherton, Murphy 2014). Quality assessment, which focuses on identifying bottlenecks and challenges in a system rather than merely unsatisfactory performers, is an important part of quality assurance (Tobin-West and Anastasia 2016).
An estimated 289 000 women perish each year as a result of problems linked with pregnancy and childbirth. In addition, around 6.6 million children under the age of five died as a result of neonatal problems and early childhood illness (World Health Organization (WHO), 2013). These deaths can be avoided if quality and optimal mother and child health care is provided in health institutions.
Despite significant advances in several areas of reproductive, women’s, and children’s health treatments throughout the years, efforts to enhance maternal and child health outcomes have made little headway due to a large disparity between the scope and quality of health care given in facilities (WHO, UNICEF, 2014).
Approximately 500,000 women and girls die each year as a result of complications related to pregnancy, labor, and the first six weeks after delivery. The majority of these deaths occur in developing nations (UN Millennium Development Goals 2009), making childbirth one of the most dreaded experiences for women of childbearing age. This is concerning to some because statistics suggest that maternal mortality from pregnancy and childbirth is increasing in low and middle income nations (United Nations Children Fund (UNICEF) Nigeria, 2014).
In Nigeria, the chance of death from conception and childbirth is a 1 to 13 ratio. In Nigeria, around 2,300 children under the age of five and 145 women in their reproductive years die every day.
With these numbers, Nigeria was ranked as the world’s second highest contributor to under–five and maternal mortality. Many of these deaths may have been avoided if Nigeria’s health-care coverage and quality met or exceeded international standards for women and children. According to a report published by the United Nations International Children’s Fund (UNICEF) in Nigeria (2014), less than 20% of health facilities in the country provide emergency obstetric care (Eoc), while health professionals handle roughly 35% of deliveries.
In 1988, Nigerians created a national health policy with the goal of ensuring quality health for all. Emerging health challenges and the need to focus on new trends spurred a policy review throughout time to improve health quality. The Donabedian model was created in 1966 to analyze healthcare services and evaluate health-care quality. The model was revised in 1988, and it uses three categories to provide information about the quality of care: structure, procedure, and results. The framework in which treatment is administered, including hospital facilities, staff, funding, and equipment, is referred to as structure. The transactions between patients and healthcare providers that occur during the delivery of healthcare are referred to as the process. The consequences of healthcare on a client’s health state and satisfaction are referred to as outcomes. Other quality of care frameworks, such as the WHO-recommended Quality of Treatment Paradigm and the Bamako Initiative, have been established since then, but the Donabedian Model remains the leading framework for assessing the quality of care.
Maternal health care refers to the treatment a woman receives during her pregnancy, birth, and recovery. It is critical for the mother’s and child’s life and well-being. It includes a wide range of services such as family planning, prenatal, intrapartum, and postpartum care, all with the goal of reducing maternal mortality and disability (Franny, 2013).
Improving the quality of obstetric treatment in facilities has lately been identified as a neglected but critical strategy for reducing maternal fatalities and enabling poor nations to meet Sustainable Development Goal 3 (SDG 3): good health and well-being, particularly for women (Van den Broek and Graham 2009). Postpartum hemorrhage is the leading cause of maternal death worldwide, accounting for 25% of all maternal deaths in underdeveloped countries. Following that are hypertensive disorders in pregnancy (PE/E), sepsis (8%), and obstructed labor (5%). (7 percent ). 2 There are effective therapies for screening, preventing, and treating obstetric and neonatal problems that can be delivered quickly by competent practitioners in facilities. However, ensuring high quality and coverage of these interventions is critical if maternal and newborn fatalities are to be reduced globally. The presence of a skilled birth provider and the provision of excellent care, according to international evidence (USAID/MCHIP 2013), is the most critical determinant in lowering maternal and early newborn mortality.
Poor maternal and child health indicators have been a recurring issue in Nigeria since the 1990s, according to Kana, Doctor, Peleteiro, Lunet, and Barros (2015), and various interventions have been implemented to reverse the trend and ensure that Nigeria provides quality maternal and child health care.
Various intervention reports, on the other hand, have reported varied findings in terms of successes, problems, and risks to achieving quality maternal and child health care in Nigeria. Nigeria has been noted as trailing behind in attaining MDG 4; according to UN mortality estimates, Nigeria has only achieved an average annual reduction in under-five mortality of 1.2 percent per year since 1990.
STATEMENT OF PROBLEM
The quality of prenatal care and the location of delivery are important factors in mother and child morbidity and mortality (United States Agency for International Development (USAID), 2013). Every year, about half a million women and girls die as a result of difficulties during conception, delivery, or the first six weeks after childbirth. The majority of these deaths occur in developing countries (United Nations Millennium Development Goals, 2009). In Nigeria, the risk of death from conception and delivery is 1 in 13, and many of these deaths might have been avoided with adequate coverage and high-quality maternity and child health care (UNICEF, 2014). Growing maternal and newborn mortality and morbidity have been linked to poor healthcare quality (USAID, 2013), and increased death rates have shown that a lack of reproductive health services is a major concern in Nigeria (WHO Nigeria, 2014). Despite progress in increasing coverage of several key reproductive, maternal, newborn, and child health interventions over the last two decades, there has been little progress in improving maternal and paediatric outcomes due to a significant gap between coverage and the quality of care provided in health facilities (WHO, UNICEF, 2014).
In addition, despite the presence of numerous healthcare facilities in the area, clinical practice has revealed that there are still many cases of preventable pregnancy and delivery difficulties reported on a daily basis in the teaching hospital in Ile-Ife. It is critical to increase the quality of facility-based health care services and to make quality an intrinsic part of scaling up treatments to improve maternal, neonatal, and child health outcomes (WHO, 2013).
As a result, in order to attain Sustainable Development Goal 3 (SDG 3) of excellent health and well-being, it is necessary to evaluate maternal and child healthcare services in healthcare facilities in Ile-Ife for quality care.
OBJECTIVES OF THE STUDY
The major goal of this research is to assess the quality of maternal and child healthcare services in a number of healthcare facilities in Ile-Ife using the Donabedian model for quality care.
The following are the precise goals:
1. Use the Donabedian model to examine the structure of maternal and child healthcare services in Ile-primary Ife’s and secondary health care facilities.
2. Using the Donabedian model, determine the process of maternal and child healthcare services at Ile-primary Ife’s and secondary health care facilities.
3. Using the Donabedian model for quality care, assess client satisfaction (outcome) with maternal and child healthcare services in primary and secondary health institutions in Ile-Ife.
4. Determine the types of personnel who provide maternal and child healthcare in primary and secondary health care facilities.
RESEARCH QUESTIONS
The study provided answers to the following research questions:
1. How are maternal and child healthcare services structured in Ile-designated Ife’s health facilities?
2. How are maternal and child healthcare services provided in Ile-selected Ife’s health facilities?
3. How satisfied are clients with maternal and child healthcare services provided at Ile-primary Ife’s and secondary health care facilities (outcome)?
4. What types of personnel work in Ile-health Ife’s institutions providing maternal and child healthcare?
RESEARCH HYPOTHESIS
The following hypothesis was tested at a significance level of 0.05.
HO1: There is no discernible variation in the pattern of maternal and child care.
In Ile-Ife, healthcare services are provided in primary and secondary health facilities.
HO2: There is no major difference between the maternal and pediatric healthcare processes.
Primary and secondary health care services are available.
HO3: There is no discernible difference in client satisfaction (outcome) between the two groups.
Maternal and child healthcare services are available in Ile-de-primary France’s and secondary health care institutions.
Ife.
SIGNIFICANCE OF THE STUDY
Maternal and infant morbidity and mortality remain a problem, according to a World Health Organization report (WHO 2008), with substantial disparities between rich and developing nations. As a result, the findings of this study may aid in the development of suggestions to improve the quality of maternity and child healthcare services, consequently lowering maternal and child mortality and achieving Sustainable Development Goal 3 (SDG 3): Good health and well-being.
The findings could help the Federal Ministry of Health create measures to improve the quality of maternal and child healthcare services by bringing stakeholders together.
The findings may be beneficial in improving the organization of healthcare facilities, employee training and retraining, supervision, and the availability of supplies and transportation for fast referrals in healthcare facilities, as well as in National Health Planning and Budgeting.
The findings could be beneficial in identifying places where local and international institutions can collaborate to deliver complementary maternal and child healthcare services.
The findings of the study could be utilized to push health workers to identify characteristics that influence the quality of maternal and child health care in Nigeria and where improvements are needed.
The findings could contribute to the existing body of knowledge and help Nigeria achieve its objective of providing high-quality maternity and child healthcare.
SCOPE OF THE STUDY
The study’s scope was confined to Ile-primary Ife’s and secondary healthcare facilities, as well as nursing mothers of children aged 0 to 1 year who attended infant welfare clinics in Ile-selected Ife’s healthcare facilities. Ife Central Local Government, Ife East Local Government, Ife South Local Government, and Ife North Local Government are the four local governments of Ile-Ife, respectively.
DEFINITION OF TERMS
Quality of Care: Care provided to women in Ile-Ife healthcare facilities during pregnancy, childbirth, and post-delivery based on the Donabedian Model of quality care, which includes the structure, method, and outcome of Maternal and Child Health Care services.
Maternal and Child Healthcare: This refers to the care given to a pregnant woman from conception through delivery of the infant, as well as the care given to the baby from birth to two years in Ile-healthcare Ife’s facilities.
Health Professionals: These include Midwives, Nurses, Community Health Officers, and Community Health Extension Workers who, by virtue of their training or qualifications, provide Maternal and Child Healthcare services in healthcare institutions in Ile-Ife.
Women with babies aged 0 to 1 year old who have had care throughout conception, birth, and breastfeeding
Primary Healthcare Centers (PHCs) and Secondary Health Facilities (General Hospitals and Comprehensive Health Centers) are both available in Ile-Ife.
Donabedian Model: This is Avedis Donabedian’s conceptual model of excellent care, which he established in 1966 and revised in 1980 and 1988. The model was created to evaluate the quality of care in clinical practice; it comprises three categories for gathering information for evaluating the quality of healthcare services: structure, process, and result.
Structure: This refers to the physical, human, and material resources available in Ile-primary Ife’s and secondary healthcare facilities for maternal and child healthcare.
Healthcare professionals’ care and actions in Maternal and Child health services are referred to as the process. It includes all maternal acts.
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