Women’s Satisfaction to Maternity Care and Factors Associated with Intention to Return to the Health Facility in Nepal

Presenter: Yuba Raj Paudel, Nepal Health Sector Support Program, Ministry of Health and Population, Kathmandu, Nepal

Introduction: In Nepal, as a result of demand generation and service expansion, proportions of deliveries conducted at health institutions tripled from 18% in 2006 to 55% in 2014. However, less data is available on women’s satisfaction and experience of child birth in institutional setting.  Utilizing data from a nationally representative Service Tracking Survey 2013, this study aimed to measure client satisfaction to key dimensions of maternity care.

Methods:  Exit interview with 447 recently delivered women using 8-item instrument of quality of care was used to measure client satisfaction. A correlation coefficient of ≥0.3 was considered as strong correlation for this analysis. Multivariate probit model was used to assess the attribution of each client’s satisfaction items to intention of future use of services. A p value of <0.05 indicated a statistically significant association.

Results: Mean satisfaction score was the highest for level of skill of service providers and the least for cleanliness of the facility.  Most of the respondents suggested maintaining clean/hygienic health facilities (42%), better bed provision (26%), improvement/continuity of free services (24%), more helpful behaviour from health workers (18%), and better privacy at the health facilities (9%). Satisfaction with information received showed a strong correlation with politeness of staff, involvement in decision making and satisfaction about care at facility. Similarly, satisfaction with skill of service provider also showed a strong correlation with politeness of staff and satisfaction with care received. Satisfaction with waiting time (p=0.035), information received (p=0.02) and overall care in the maternity care (<0.001) showed strong association with likelihood to return to facility.

Conclusion: Adequacy of information and less waiting time was found to increase likelihood to return to the health facility. The findings suggest improving physical environment and behaviour/interpersonal communication of service providers of public maternity care centers in Nepal.