Association between antenatal care facility readiness and provision of care at the client level and facility level in five low- and middle-income countries

BMC Health Services Research

Research

Ashley Sheffel¹  Emily Carter¹  Melinda K. Munos¹  Scott Zeger² 

[1] Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, 21205-2103, Baltimore, MD, USA;Departments of Biostatistics and International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, 21205-2103, Baltimore, MD, USA;

关键词: Quality of care;    Service readiness;    Health services research;    Health systems research;    Maternal health;    Antenatal care;    International health;    Developing countries;    Quantitative methods;   

DOI  :  10.1186/s12913-023-10106-5

 received in 2023-01-17, accepted in 2023-10-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite growing interest in monitoring improvements in quality of care, data on service quality in low-income and middle-income countries (LMICs) is limited. While health systems researchers have hypothesized the relationship between facility readiness and provision of care, there have been few attempts to quantify this relationship in LMICs. This study assesses the association between facility readiness and provision of care for antenatal care at the client level and facility level.MethodsTo assess the association between provision of care and various facility readiness indices for antenatal care, we used multilevel, multivariable random-effects linear regression models. We tested an inflection point on readiness scores by fitting linear spline models. To compare the coefficients between models, we used a bootstrapping approach and calculated the mean difference between all pairwise comparisons. Analyses were conducted at client and facility levels.ResultsOur results showed a small, but significant association between facility readiness and provision of care across countries and most index constructions. The association was most evident in the client-level analyses that had a larger sample size and were adjusted for factors at the facility, health worker, and individual levels. In addition, spline models at a facility readiness score of 50 better fit the data, indicating a plausible threshold effect.ConclusionsThe results of this study suggest that facility readiness is not a proxy for provision of care, but that there is an important association between facility readiness and provision of care. Data on facility readiness is necessary for understanding the foundations of health systems particularly in countries with the lowest levels of service quality. However, a comprehensive view of quality of care should include both facility readiness and provision of care measures.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

12951_2017_270_Article_IEq5.gif

Fig. 4

12951_2015_155_Article_IEq9.gif