Evaluating the Responsiveness of Childbirth Services in Murangá County Referral Hospital

Abstract

Evaluating the quality of healthcare delivery is an important policy and theoretical concern. The expansion of the system's domain and the inclusion of both supply- and demand-side considerations are two examples of the proposed frameworks that aim to make the health system more responsive. Deficiencies in responsiveness are revealed by secondary research in a variety of settings. This study evaluated the responsiveness of childbirth services Murang'a County Referral Hospital (MCRH) to understand why despite the implementation of a free maternity program, uptake of skilled birth attendance remained relatively low. The study looked into both the overall quality of maternal care services and contributing factors. This was done with four research objectives; i) To determine the influence of access factors on responsiveness during childbirth in MCRH ii) To establish the influence of maternal characteristics on responsiveness during childbirth in MCRH iii) To determine the influence of structural factors on responsiveness during childbirth in MCRH iv) To establish the influence of the process of care factors on responsiveness during childbirth in MCRH. Using quantitative data collection techniques, a descriptive approach was taken. Postnatal women who gave birth at MCRH were given a structured questionnaire via systematic random sampling. The data were analyzed using R software, with chi-square used to test for associations and binary logistic regression used for multivariate analysis. Odds ratios, confidence intervals, the total number of respondents, and percentages were used to present the data. 88 (69%) of the 129 participants in the sample provided comprehensive data for both variables. Many of the respondents had less than five children, were single, young, married, and living in rural areas. The domains of dignity, autonomy, and communication were highly rated, with room for improvement in the confidentiality domain. Distance covered to get to the hospital (OR= 0.206 95% CI 0.053-0.801), costs of accessing care OR=0.159 95% CI 0.039-0.639), and the provision of culturally respectful services (OR=0.07 95% CI 0.009-0.545) were found to influence responsiveness. Marital status (OR: 11.958 95% CI 1.178-121.376), commodity availability, adequacy of beds (P<0.005), and language use during labor were also significant contributors. Overall, MCRH has responsive childbirth services. However, the low utilization of skilled birth attendance may be attributed to distance to the hospital, care costs, lack of supplies, inadequate beds, and language use during labor. There is need for the county government to invest in the supply-side needs of the health system to promote responsive childbirth services at MCRH.