Strategies that promote high quality care in Indonesia

Objectives To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia.Data sources The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers.Study design Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance.Data collection methods Quality available is measured by provider adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received.Principle findings High facility quality predicts an increase in quality received. Although poor households have access to the same or higher quality care compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth.Conclusions Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated.