Project Materials

UTILIZATION OF DONABEDIAN MODEL IN EVALUATION OF MATERNAL AND CHILD HEALTHCARE QUALITY SERVICE

CHAPTER ONE

INTRODUCTION

1.1 The Background of the Study 

Maternal and infant morbidity and mortality are significantly influenced by the quality of prenatal treatment and the location of birth. Concerns and recurring issues throughout the year have focused on maintaining and raising the standard of treatment in healthcare facilities.

When patients express satisfaction with the quality of their care, managers, policymakers, and healthcare professionals can use this information to guide efforts to enhance quality (Beattie, Lauder, Atherton, Murphy 2014).

According to Tobin-West and Anastasia (2016), quality evaluation is a crucial component of quality assurance, which focusses on identifying obstacles and difficulties in a system rather than only poor performance.

According to reports, pregnancy and childbirth problems claim the lives of 289 000 women annually on average. Additionally, problems during the newborn period and early childhood illnesses caused the deaths of around 6.6 million children under the age of five (World Health Organisation (WHO), 2013). By providing high-quality and optimal maternity and child health care in medical institutions, these deaths can be avoided.

Due to a significant disparity between the scope and quality of healthcare offered in facilities, efforts to improve maternal and child health outcomes have not made much headway, despite notable accomplishments in certain areas of reproductive, women’s, and children’s health interventions over the years (WHO, UNICEF, 2014).

The Global Strategy for Every Woman and Child and other international programs place a high priority on quality of care.

Every year, problems from pregnancy, childbirth, and/or the six weeks following delivery claim the lives of over 500,000 women and girls.

According to the United Nations Millennium Development Goals (2009), the majority of these deaths occur in less developed nations, making childbirth one of the most dreaded experiences for women of childbearing age.

Some people are concerned about this because statistics indicate that maternal mortality from pregnancy and delivery is rising in low- and middle-income nations (United Nations Children Fund (UNICEF) Nigeria, 2014).

In a similar vein, Nigeria has a 1 to 13 probability of death from pregnancy and childbirth. In Nigeria, 145 women in their reproductive years and 2,300 children under five pass away per day. Based on these numbers, Nigeria was ranked as the second-largest contributor to maternal and under-five mortality worldwide.

Nigeria’s coverage and quality of health care services, which still fall short of expectations for women and children, may have avoided many of these deaths.

About 35% of deliveries are handled by medical professionals, and less than 20% of Nigerian health institutions offer emergency obstetric care (Eoc), according to a 2014 United Nations International Children Fund (UNICEF) report.

The goal of a national health strategy created for Nigerians in 1988 was to provide high-quality healthcare for everyone. The policy has been reviewed over the years to improve the quality of health care services throughout the country due to emerging health challenges and the need to focus on new trends (Nigeria Demographic Survey, 2013).

For this population, high-quality reproductive care must be provided through a health delivery system that aims to lower maternal morbidity and mortality (United States Agency for International Development (USAID), 2013).

In 1966, the Donabedian model was created to evaluate healthcare services and care quality. The model, which was updated in 1988, uses three categories—structure, procedure, and outcomes—to offer information regarding the quality of care.

The setting in which care is provided, including hospital facilities, personnel, funding, and equipment, is referred to as the structure. Transactions between patients and medical staff during the course of providing healthcare are included in the process.

The term “outcomes” describes how healthcare affects a patient’s health and level of satisfaction. Since then, other frameworks for evaluating the quality of healthcare have been developed, such as the Bamako Initiative and the Quality of Care Framework recommended by the World Health Organisation (WHO), but the Donabedian Model remains the most widely used framework for doing so today (Lawson and Yazdany 2012).

Key indicators for quality in maternal, newborn, and child health care were developed in 2013 by the World Health Organisation and the Partnership for Maternal, Newborn, and Child Health using the Donabedian model.

Care given to a woman during pregnancy, childbirth, and the postpartum period is known as maternal health care, and it is essential to both the mother’s and the child’s survival and well-being.

With the goal of reducing maternal death and disability, it includes a wide range of services such as family planning, prenatal, intrapartum, and postpartum care (Franny, 2013).

A neglected but crucial strategy for lowering maternal deaths and helping developing nations reach Sustainable Development Goal 3 (SDG 3), which is good health and well-being, particularly for women, is to improve the quality of obstetric care provided in facilities (Van den Broek and Graham 2009).

With 25% of maternal mortality occurring in developing nations, postpartum haemorrhage is the leading cause of maternal deaths worldwide. Then come obstructed labour (7%), sepsis (8%), and hypertensive disorders in pregnancy (PE/E) at 15%.2

There are effective therapies for screening, preventing, and treating obstetric and infant problems, and competent providers may easily offer these in facilities.

However, reducing maternal and neonatal deaths worldwide requires both high quality and coverage of these therapies.

According to international data, having a trained delivery provider present and receiving high-quality care are the most crucial factors in lowering maternal and early newborn death (USAID/MCHIP 2013).

Poor maternal and child health indicators have been a persistent problem in Nigeria since the 1990s, and numerous interventions have been put in place to buck the trend and guarantee that Nigeria offers high-quality maternal and child health care (Kana, Doctor, Peleteiro, Lunet, & Barros, 2015).

Nonetheless, a number of intervention reports have shown conflicting results regarding the obstacles, difficulties, and dangers to obtaining high-quality maternity and paediatric healthcare in Nigeria. Nigeria has only reduced under-five mortality by an average of 1.2% year since 1990, according to UN mortality figures, and it has been noted that the country is falling behind in achieving MDG 4.

Additionally, Nigeria had to have achieved a 10% annual reduction rate in the five years preceding up to 2015 in order to accomplish MDG 4 (Rajaratnam, Marcus, Flaxman, Wang, Levin-Rector, Dwyer, et al., 2010).

at order to enhance the health outcomes of mothers, babies, and children, it is crucial to improve and ensure the quality of health care services at medical facilities. Developing strategies for quality is a crucial part of scaling up interventions in this regard (WHO, 2013).

1.2 The Statement Of The Problem 

Maternal and child morbidity and mortality are significantly influenced by the quality of care received during pregnancy and the location of delivery (United States Agency for International Development (USAID), 2013).

Every year, nearly half a million women and girls worldwide pass away due to complications during conception, delivery, or the six weeks following childbirth.

According to the United Nations Millennium Development Goals (2009), the majority of these fatalities occur in developing countries.

In Nigeria, the chance of dying during pregnancy and childbirth is 1 in 13, and many of these deaths might have been prevented with adequate coverage and high-quality treatment for mothers and children (United Nations International Children Fund (UNICEF), 2014).

Poor quality healthcare services have been associated to higher rates of maternal and newborn death and morbidity (USAID, 2013). Inadequate access to reproductive health services is a significant problem in Nigeria, as evidenced by rising death rates (WHO Nigeria, 2014).

Due to a significant discrepancy between coverage and the standard of care given in medical facilities, there has been little progress in improving maternal and paediatric outcomes, despite advancements in expanding the coverage of several important reproductive, maternal, newborn, and child health interventions over the past 20 years (WHO, UNICEF, 2014).

Clinical practice has also shown that, despite the abundance of healthcare resources in the area, many cases of avoidable pregnancy and delivery difficulties are nevertheless reported daily in the teaching hospital in Ile-Ife.

It is crucial to raise the standard of facility-based health care services and make quality a key element of expanding treatments to enhance the health of expectant mothers, babies, and kids (WHO, 2013).

Therefore, in order to attain Sustainable Development Goal 3 (SDG 3), which is good health and well-being, it is necessary to assess the maternal and child healthcare services provided at Ile-Ife healthcare facilities for quality care.

1.3 The Objectives of the Study

This study’s primary goal is to use the Donabedian model for quality care to assess the quality of maternal and child healthcare services at a few chosen healthcare facilities in Ile-Ife.

The particular goals are to:

1. evaluate, using the Donabedian model, the organisation of maternity and child healthcare services in Ile-Ife’s primary and secondary healthcare institutions;

2. determine, using the Donabedian model, the maternal and child healthcare services process in Ile-Ife’s primary and secondary health facilities;

3. Using the Donabedian paradigm for quality care, evaluate the client’s satisfaction (outcome) with the maternity and child healthcare services provided in Ile-Ife’s primary and secondary healthcare facilities.

4. Identify the types of employees providing maternity and paediatric care at Ile-Ife’s main and secondary healthcare facilities.

1.4 Research Questions

The study provided answers to the following research questions:

1. How are the healthcare services for mothers and children organised at a few Ile-Ife health facilities?

2. How do some medical facilities in Ile-Ife handle maternal and paediatric healthcare services?

3. How satisfied are patients with the maternity and paediatric healthcare services provided at Ile-Ife’s primary and secondary healthcare facilities?

4. Which staff members are providing maternity and paediatric healthcare services in Ile-Ife’s medical facilities?

1.5 Theories

The 0.05 threshold of significance was used to evaluate the following hypotheses.

HO1: There is no significant variation between the structure of Maternal and Child

medical care in Ile-Ife’s primary and secondary healthcare facilities.

HO2: The procedures for maternal and paediatric healthcare do not differ much.

primary and secondary healthcare establishments’ services.

HO3: The client’s pleasure (result) does not significantly differ between

Healthcare services for mothers and children in primary and secondary healthcare facilities in the island

Ife.

1.6 The Scope of the Study

This study’s scope was restricted to Ile-Ife primary and secondary healthcare facilities, as well as nursing mothers of children aged 0–1 who visited infant welfare clinics at particular Ile-Ife healthcare facilities. The four local governments of Ile-Ife—Ife Central, Ife East, Ife South, and Ife North, respectively—are taken into consideration in this study.

1.7 Significance of the Research

The World Health Organisation Report (WHO 2008) states that there is still a significant gap between industrialised and developing nations in terms of maternal and neonatal morbidity and mortality.

In order to reduce maternal and child mortality and accomplish Sustainable Development Goal 3 (SDGs), which is Good Health and Well-Being, the results of this study may thus aid in making recommendations to enhance the quality of healthcare services for mothers and children.

Through stakeholder collaboration, the findings could help the Federal Ministry of Health implement measures to enhance the quality of healthcare services for mothers and children.

The results could help National Health Planning and Budgeting with bettering healthcare facility structure, staff training and retraining, monitoring, and supply and transportation service for timely referrals in healthcare facilities.

The results might offer helpful details about how to collaborate with regional and global organisations to play a complementary role in maternal and paediatric healthcare services.

The study’s findings could be used to push medical practitioners even harder to pinpoint the variables affecting the standard of maternity and paediatric healthcare in Nigeria and where improvements are needed.

The results could contribute to the body of information already in existence and help Nigeria reach its objective of providing high-quality healthcare services for mothers and children.

1.8 Definition of Terms 

Quality of Care: Pregnancy, childbirth, and postpartum care provided to women at Ile-Ife healthcare facilities according to the Donabedian Model of quality care, which encompasses the organisation, procedure, and results of maternal and child health care services.

Maternal and child healthcare refers to the treatment provided in Ile-Ife medical facilities to a pregnant woman from the moment of conception until the baby is delivered, as well as to the infant from birth to two years of age.

Health Professionals: Based on their education or credentials, midwives, nurses, community health officers, and community health extension workers offer maternal and child healthcare services in Ile-Ife healthcare facilities.

Nursing Mothers: Women with children aged 0–1 who have received treatment during pregnancy, birth, and the postpartum period, as well as family planning, vaccinations, and baby care, and who attend immunisation clinics during the study period at certain health facilities in Ile-Ife.

General hospitals and comprehensive health centres are examples of secondary healthcare facilities in Ile-Ife, as are Primary Healthcare Centres (PHCs).

Donabedian Model: Avedis Donabedian created this conceptual model of quality care in 1966, and it was re-examined in 1980 and 1988. The model, which was created to evaluate the quality of care in clinical practice, contains three categories—structure, procedure, and outcome—where data can be collected to measure the quality of healthcare services.

The physical infrastructure, personnel, and material resources that are available at basic and secondary healthcare institutions for maternal and paediatric healthcare services in Ile-Ife are referred to as the structure.

Process: This refers to the treatment and other activities carried out by medical professionals in maternal and child health services.

It includes all interactions between medical staff and patients, including relationships and respectful maternity care during interactions, as well as all acts of maternal and child healthcare delivery (antenatal, intranatal, postnatal, neonatal, and children’s care, among others) in healthcare facilities in Ile-Ife.

Result: Mother satisfaction with care obtained in Ile-Ife primary and secondary healthcare institutions is a measure of the impact of maternal and child healthcare services.