Providers' Perception of Quality of Care and Constraints to Delivery of Quality Maternal Health Services in Primary Health Centers of Enugu State, Nigeria

摘要

Aims: The aim of the study was to assess providers’ perception of quality of care and constraints to delivery of quality maternal health services in urban and rural primary health centers of Enugu state, Nigeria. Study Design: This was a qualitative descriptive study. Methodology: A descriptive study design using qualitative data collection and analysis method. Data was collected through a face to face in-depth interview using an interview guide between May and June 2013. A total of 24 providers participated in the study. They included six heads of department of health of six local government areas and officers-in–charge of eighteen primary health centers in urban and rural areas of Enugu state, Nigeria. Results: Most of the providers perceived the quality of maternal health services in the primary health centers as good and they attributed this to results that were achieved. On measures the providers adopted to ensure clients satisfaction, most of the providers in the urban favoured good work attitude while those in the rural relied on provision of incentives. Inability of the health centers to remain open round the clock was identified as the major constraint to the delivery of quality maternal health care in the health centers and this was attributed to the prevailing security challenges in the study area. Other constraints included inadequate number of health workers, poor amenities, and inadequate equipment. Conclusion: The providers in the study area perceived good quality care to be the same as good utilization of services at the health centers. This has made them to adopt client friendly measures like good work attitude and use of incentives to encourage the clients to utilize the health centers. This may invariably lead to good quality care. Also, they view situations that limit access to services at the health centers as constraints to delivery of quality maternal health care. The providers need adequate support from the local government authorities who are the custodians of primary health care in Nigeria and they should also involve the host communities in the discharge of their duties. The primary health centers should be adequately fenced and personnel employed for security purposes as this will improve access primarily and then good quality care. There is also the need to train the health workers specifically on good quality care.