Determinants of maternal child health service quality in tier three public health facilities, Kisumu county, Kenya

Abstract

Compromised Maternal Child Health (MCH) service quality is increasingly being linked to failure to attain expected healthcare improvements in Low and Middle-Income Countries. Kenya’s Free Maternity Services (FMS) (Linda Mama) initiative removed user fees for MCH services with the aim of increasing service uptake and improving MCH service quality. This led to increased patient load, as a result, overstretching health facilities resources. There were concerns of declining service quality and hence, the need to identify the determining factors. Service quality is complex but is conventionally considered in terms of structure (facility characteristics, equipment and human resources); process (provider-patient interaction) and outcomes (users’ perspectives) dimensions. The study focused on tier three public health facilities of Kisumu County. Specifically, it assessed the mothers’ socio-economic and demographic characteristics associated with MCH service quality; healthcare workers’ characteristics associated with MCH service quality; healthcare service delivery processes associated with MCH service quality and healthcare structural factors associated with MCH service quality. Through analytical cross-sectional design, facility-level data were collected from a sample of 334 mothers, 81 healthcare workers using structured questionnaires and 7 Key Informant Interviews. Variable characteristics were summarized descriptively. The association of healthcare structural aspects and MCH service quality was assessed through Principal Component Analysis. About 52% of mothers were aged between 20 and 29 years, 71.9% were married and 64% had achieved post-primary education while about half lived below poverty line. Mothers of para 1 (aOR= 2.29, 95%CI=1.04-2.05, p-value= 0.040) or para 2 (aOR= 3.22, 95%CI=1.54-2.70, p-value=0.002); rural residence (aOR=2.24, 95%CI=1.05- 2.79, p-value= 0.037) perceived services to be of quality. About half (49.4%) of healthcare workers were aged between 20 – 29 years. Of these, 46.3% were Nursing Officers of whom 57.5% were Diploma holders and 28.4% were university graduates. Being a university graduate (aOR= 21.29, 95%CI=1.15 - 2.16, p-value=0.04) and deployment in a department for six months (OR=7.22, 95%CI= 1.3-2.22, p-value=0.024) were healthcare workers’ characteristics associated with MCH service quality. Healthcare service delivery processes associated with MCH service quality were clinical examination (OR=11.33, 95%CI=2.55- 3.35, p-value=0.001); laboratory malaria investigations (OR=3.21, 95%CI=1.71-2.03, p=value=<0.001); child immunization (OR=1.82, 95%CI=0.62-1.30, p-value=0.027); health education and mentorship (p-<0.001). Having the 5 listed staff cadres [aOR 2.16, CI=1.15- 4.05 & p=0.016) was associated with MCH service quality. Facilities with antenatal ward (0.3189), Medical Officer (0.3189) and a suction machine (0.2867) had higher factor loading. This study result indicated older mothers had low perception of MCH service quality while those with low parity and residence of rural areas were more likely to report having received MCH service quality. Healthcare workers with Higher National Diploma (HND) were less likely to offer MCH service quality while being deployed in a department for 6 months was more associated with MCH service quality. Received Syphilis test was less associated with MCH service quality. Having Medical Officer, Nursing Officer, Nutritionist, Obstetrician/gynaecologist, Pharmaceutical Technologist) contributed more to MCH service quality as compared to physical structures and equipment. The study will help in designing and implementation of MCH programs and training of healthcare workers for improvement of MCH service quality in Kisumu County