UTILIZATION OF DONABEDIAN MODEL IN EVALUATION OF MATERNAL AND CHILD HEALTHCARE QUALITY SERVICE IN SELECTED HEALTH CARE FACILITIES IN ILE-IFE
ABSTRACT
Improving the quality of obstetric, neonatal and child care in facilities has been identified as a neglected and essential approach to reducing maternal deaths and enabling developing countries to achieve Millennium Developments Goals 4 and 5 which are reduction in maternal and infant mortality, and also, Sustainable Development Goal 3 (SDG 3) which is good health and well- being especially for women.
This study employed a descriptive design to evaluate the quality of Maternal and Child Health care (MCH) services in selected health facilities in Ile-Ife utilizing Donabedian model for quality care.Sample size was determined using Leslie Kish formula. Data were collected in selected 45 Primary Health Care centres (PHCs) and 7 Secondary health facilities (SHFs) using an adapted checklist. Data were also collected from 330 selected nursing mothers using an adapted questionnaire on client’s satisfaction (outcome) with the maternal and child healthcare services. Four research questions were answered and three hypotheses were tested at 0.05 level of significance.
Findings of the study reveal that majority of the Heads of the Maternal and Child Health Care units surveyed are females (90.4%),all the SHFs are charged by professional Nurses and Midwives while only 13 out 45 PHCs are charged by professional Nurses/Midwives. Three hundred and thirty (330) nursing mothers participated in the study, 180 (54.5%) mothers were 19-28 years, and only 5 (1.5%) respondents were below 19 years. 232 (70.3%) of the mothers were from PHCs and 98 (29.7%) were from secondary health facilities. In terms of structure, 34 (75.6%) of PHCs and 5 (71.4%) of SHFhave personnel with inadequate training in MCH services mean 2.67±2.50 and 3.29±2.36 respectively. Thirty six (80%) of PHCs and 3 (42.9%) of SHF shave physical facilities that were not in good working condition mean 57.29±11.48 and 44.4±12.23 respectively. In terms of process, finding shows that majority of MCH services rendered in both the PHCs and SHFs are sometimes (100%) done, mean 70.22±8.64 and 73.29±9.98 respectively. The clients’ satisfaction survey reveal that majority of clients were satisfied with the MCH services in both Primary and Secondary health facilities in Ile-Ife, mean were 115.1±15.86 and 110.37±14.71 respectively. Findings of the study also show that most staff rendering MCH services in PHCs are Community Health Extension Workers and Health attendants There is a significant difference between the structure of MCH services p = 0.04, no significant difference between the MCH services p = 0.46 and client satisfaction p = 0.10 in PHCs and SHFs, p = 0.10.
The quality of Maternal and Child health services in both Primary and Secondary health facilities in Ile –Ife were below the standard as reflected in the findings. Therefore, government efforts at all levels should be directed towards improving the structure of healthcare facilities, training and retraining of staff, supervision, and provision of supplies and transportation for prompt referrals in health facilities through a robust National Health Planning and collaboration between stake holders.
Keywords: Evaluation, Quality, Maternal and Child Health services, Structure, Process Outcome.