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Perceived Gaps in Quality of Antenatal Care at Some Primary Health Centres Perceived gaps in quality of antenatal care at some Primary Health Centres... NIGER DELTA MEDICAL JOURNAL Daprim S. Ogaji, Ikenna C. Erugoh, Ebele I. Nkwogbo, Izuchukwu I. Okpara, Margaret M. Mezie-Okoye. PERCEIVED GAPS IN QUALITY OF ANTENATAL CARE AT SOME PRIMARY HEALTH CENTRES IN OBIO-AKPOR, NIGERIA Daprim S. Ogaji (MBBS, MQI, FMCPH), Ikenna C. Erugoh (MBBS), Ebele I. Nkwogbo (MBBS), Izuchukwu I. Okpara (MBBS), Margaret M. Mezie-Okoye (MBBS, MPH, FMCPH) Department of Preventive and Social Medicine Faculty of Clinical Sciences University of Port Harcourt Choba, Nigeria. Corresponding Author Dr Daprim S. Ogaji MBBS, MQI, FMCPH Address: Department of Preventive and Social Medicine, University of Port Harcourt Phone Number: +2348177092225 E-mail: [email protected], Niger Delta Medical Journal 2017; 1(2): 19-31 ABSTRACT than perception score (Mean = 3.56, S.E. = 0.042). Background: The perceptions and expectations of Overall mean gap score was -0.74, 95%CI (-0.82, - patients are important considerations when defining 0.66) and there was statistically significant quality of health care. Study estimated “quality gaps” difference between overall expectation and based on clients' expectations before receiving service perception of the clients [t(317) = 17.2, p <0.001]. and their perceptions afterwards along various service Clients' expectations had moderate but statistically characteristics of primary health care centres in Obio- significant influence on their perceptions [r = 0.31, Akpor. 95%CI (0.19, 0.41), p < 0.001]. Patient factors identified as drivers of these gaps were younger age METHODOLOGY: Analytic cross-sectional study (p = 0.01), primary education (p = 0.002) and non- using 319 regular clients from Rumuigbo and working women (p = 0.001). Ozuoba primary health centres in Obio-Akpor. Self-rated assessments were taken on the CONCLUSION: Study revealed the level and expectations of ANC clients before actual predictors of unmet expectations of pregnant encounter with the service and their perceptions women attending antenatal care. While these on the same criteria after encounter with the findings may have important clinical and policy service. The gaps between clients' expectations implications, further investigations into the root and perceptions on the 22 aspects under the causes of these gaps are required. Interventions that tangible, reliability, responsiveness, assurance would re-organize ANC services around clients' and empathy dimensions in the SERVQUAL needs and expectations would be needed. instrument were reported using descriptive and analytic statistics conducted using SPSS version Keywords: Clients, antenatal care, service quality, 20. SERVQUAL, Port Harcourt, primary health centre Result: Response rate was 94.7% and the mean expectation score of 4.30 (S.E. = 0.029) was more Nig Del Med J 2017; 1(2): 13-18 Page 19 Perceived gaps in quality of antenatal care at some Primary Health Centres... NIGER DELTA MEDICAL JOURNAL Daprim S. Ogaji, Ikenna C. Erugoh, Ebele I. Nkwogbo, Izuchukwu I. Okpara, Margaret M. Mezie-Okoye. Access and utilization of ANC services at PHC will be enhanced if the services are tailored to meet the needs and expectations of the pregnant women. Study examined the gaps between clients’ expectations before use and perceptions after use of ANC service using the SERVQUAL tool and further explored determinants of these gaps. – Statistically significant gaps in perceived service quality across all measured attributes of ANC. Some predictors of these gaps include younger age, lower level of education and unemployment. – Need for further investigation into the root causes of these gaps and realign ANC service around clients’ expectation. INTRODUCTION clients, perception is their evaluations (judgments More than half a million women die every year of aspects or entire health care) of health care (18). from complications of pregnancy, childbirth Both perception and expectation are often viewed as and abortion (1). Nigeria with a reported maternal being related as the perception of clients is a mortality ratio of 576 per 100,000 live births (2) reflection of the level of fulfillment of their contributes significantly to these deaths and was expectations (21-23). It can be argued that unmet unable to meet previous critical targets agreed by expectations will result in frustration, the United Nations for coverage for antenatal care dissatisfaction and poor utilization of ANC. and assisted delivery services (2, 3). Patients' feedback had become a recognised and Quality antenatal care remains a major pillar of legitimate method of evaluating health care (24). safe motherhood and being a service intervention, Although there are a number of studies reporting can mitigate the current high maternal mortality(4) . patients' assessment of the quality of antenatal care, Current concerns to achieve safe motherhood is not much data on perceived gaps in service quality bringing into focus the neglected quality agenda as of ANC are available in Nigeria. Investigating the evident is the number of recent studies on the gap between the expectation and the perception of quality (5, 6), content (2, 7, 8), venue (2, 9, 10) and ANC clients could provide a useful prelude to the predictors of high quality antenatal care ''(11, 12) in development of client-focused antenatal service developing countries. (25). Importantly, this is a crucial aspect of the Patients' views are increasingly being used for reforms in service delivery which seek to reorganize measuring the quality of health care globally (13) health services around clients' expectations and and in sub-Saharan Africa ''(14). Understanding ensuring that the services are socially relevant and quality through the eyes of the patients shows responsive to the current and changing needs of the quality as being a reflection of the extent to which population (26). This study aims to ascertain if gaps the stated or implied needs of the patients are met exist in service quality of antenatal care delivered at (15, 16). The use of patients' views in the primary health centres, explore the influence of assessment of health care quality is underpinned client's expectations on their perceptions and by current standards in ethics, philosophy, law, identify some clients' factors that predict their politics and evidence of practical derivable expectation, perception and gaps between their benefits (17-20). While expectation reveal the expectations and perception along service preferences (ideas about what should occur) of the attributes assessed in this study. Nig Del Med J 2017; 1(2): 19-31 Page 20 Perceived gaps in quality of antenatal care at some Primary Health Centres... NIGER DELTA MEDICAL JOURNAL Daprim S. Ogaji, Ikenna C. Erugoh, Ebele I. Nkwogbo, Izuchukwu I. Okpara, Margaret M. Mezie-Okoye. METHODS Where Study setting: n = sample size; σ = estimate of standard deviation of the Study was conducted in greater Port Harcourt population. For a 5 point scale this is calculated as which is the hub for medical services in Rivers 5[inclusive range of scale] divided by 4[number of State, Nigeria. Greater Port Harcourt area spans standard deviation] = 1.25 (27), Zα/2 = standard normal eight local governments and has a projected deviation corresponding to selected a level of 0.025 in each population of two million people. This area has tail = 1.96; Z = desired power (typically 0.84 for 80% prominent tertiary health institutions such as the β power); d = Study is powered to detect a difference of 5% University of Port Harcourt Teaching Hospital, Braithwaite Memorial Specialist Hospital (BMH) in the mean expectation and perception scores of these and Kelsey Harrison Hospital. There are many clients to be significant. This is equivalent to a difference primary health care centers and privately owned of 0.2 units on a 5 point (1 – 5) rating scale (28). hospitals that are catering the healthcare needs of Calculated sample size of 306 was increased by 10% to the population. account for non-response or inappropriately filled Study facilities: questionnaire. This resulted in a minimum of 337 Study was undertaken in primary health care respondents for this study (PHC) facilities which are first-line health units Sampling method: that provide affordable services to majority of the A two-stage approach wasused in recruiting respondents people. The health centres in Obio-Akpor are for this study. In the first stage, Ozuoba Primary Health supervised by the Primary Health Care Board and Centre and Rumuigbo Primary Health Centre were manned by doctors, pharmacists, staff nurses and selectedoutofasampleframeofallPHCsinthestudyarea other health staff. The health staff offers services by simple random sampling. Selection of respondents such as medical treatments, infant immunization, from each centre was by systematic sampling using a family planning, and antenatal care. sample fraction of 1:4 on the sample of those registered Study design: Study used an analytic, cross-sectional design with daily for antenatal care during the period of data data collected between 20th November 2014 and collection. 10th May, 2015. Study instrument: Study population: The eligible populations for this study were pregnant women who registered for The SERVQUAL tool is a quality management and had attended at least two previous antenatal framework developed in the mid-1980s by visits in their index pregnancy. We excluded very Zeithaml, Parasuraman and Berry (29, 30) to sick patients and pregnant health workers
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