Care seeking during pregnancy: testing the assumptions behind service delivery redesign for maternal and newborn health in rural Kenya.

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Kevin Croke, David Kapaon, Kennedy Opondo, Jan Cooper, Jacinta Nzinga, Easter Olwanda, Nicholas Rahim, Margaret E Kruk
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引用次数: 0

Abstract

A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy's theory of change. We analyse data on place of delivery, travel time and distance, out-of-pocket spending, and self-reported quality of care for 19 127 women prospectively enrolled during antenatal care (ANC) and surveyed two times after their delivery. We analyze changes in womens' delivery location preferences in recent years in Kakamega, and over the course of their most recent pregnancy. We also evaluate travel time, out-of-pocket expenditures and patient satisfaction for women who deliver in public hospitals vs primary health centres. We find substantial changes in delivery location at the population level over time and for individual women over the course of pregnancy. Facility delivery has increased from 50.4% in 2010 to 89.5% in 2019; 70% of respondents deliver at a different facility than their reported intention at ANC. Out-of-pocket delivery expenditures are on average 1351 Kenyan shillings (Ksh) in hospitals compared to 964 Ksh in PHC (primary health care)s (P < 0.01). Transport expenditures are 337 Ksh for PHC level deliveries vs 422 Ksh for hospitals (P < 0.01). Self-reported average travel time is 51 min (PHC delivery) vs 47 min (hospital delivery) (P = 0.78). The average distance to a delivery location is 15.1 km for PHC deliveries vs 15.2 km for hospitals (P = 0.99). There were no differences in overall patient-reported quality scores, while some subcomponents of quality favoured hospitals. These findings support several key assumptions of the SDR theory of change in Kakamega County, while also highlighting important challenges that should be addressed to increase the likelihood of successful implementation.

孕期求医:检验肯尼亚农村地区孕产妇和新生儿健康服务提供改革背后的假设。
一项名为 "孕产妇和新生儿健康服务提供再设计 "的医疗系统改革,旨在通过加强医院层面的医疗服务,使医院分娩成为孕妇的默认选择,从而在肯尼亚西部的卡卡梅加县普及高质量的分娩护理。通过对卡卡梅加县新生儿母亲的大规模前瞻性调查,我们研究了支持 "服务提供再设计 "政策变革理论的几个关键假设。我们分析了 19127 名产妇的分娩地点、旅行时间和距离、自付费用以及自我报告的护理质量等数据,这些数据都是产前护理的前瞻性登记数据,并在产妇分娩后进行了两次调查。我们评估了妇女在怀孕期间对分娩地点的偏好,并与之前的怀孕情况进行了比较,还比较了在公立医院和初级保健中心分娩的妇女的旅行时间、自付费用和患者满意度。我们发现,随着时间的推移,人口层面上的分娩地点发生了很大变化,个别妇女在怀孕期间的分娩地点也发生了很大变化:在医疗机构分娩的比例从 2010 年的 50.4% 上升到 2019 年的 89.5%;70% 的受访者在不同的医疗机构分娩,而非其在产前检查时所报告的意向。在医院分娩的自费支出平均为 1351 肯尼亚先令(肯尼亚先令),而在初级保健中心分娩的自费支出为 964 肯尼亚先令(p)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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