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Assessing and understanding quality of care in a labour ward: A pilot study combining clinical and social science perspectives in Gondar, Ethiopia

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  • Pitchforth, Emma
  • Lilford, Richard J.
  • Kebede, Yigzaw
  • Asres, Getahun
  • Stanford, Charlotte
  • Frost, Jodie

Abstract

Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources. The discussion focuses on implications for informing quality improvement interventions. Improvements will need to address health systems issues, such as supply of key drugs, as well as changes in professional practice to promote the rational use of drugs. Furthermore, the study considers the need to understand broader organizational factors and inter-professional relationships. The potential for greater integration of social science perspectives as part of currently increasing monitoring and evaluation activity around intrapartum care is highlighted.

Suggested Citation

  • Pitchforth, Emma & Lilford, Richard J. & Kebede, Yigzaw & Asres, Getahun & Stanford, Charlotte & Frost, Jodie, 2010. "Assessing and understanding quality of care in a labour ward: A pilot study combining clinical and social science perspectives in Gondar, Ethiopia," Social Science & Medicine, Elsevier, vol. 71(10), pages 1739-1748, November.
    • Handle: RePEc:eee:socmed:v:71:y:2010:i:10:p:1739-1748
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    1. Arnold, Rachel & van Teijlingen, Edwin & Ryan, Kath & Holloway, Immy, 2018. "Parallel worlds: An ethnography of care in an Afghan maternity hospital," Social Science & Medicine, Elsevier, vol. 216(C), pages 33-40.
    2. Gili Hrusa & Mark Spigt & Tariku Dejene & Solomon Shiferaw, 2020. "Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)," PLOS ONE, Public Library of Science, vol. 15(2), pages 1-18, February.
    3. Vestering, Asra & de Kok, Bregje C. & Browne, Joyce L. & Adu-Bonsaffoh, Kwame, 2021. "Navigating with logics: Care for women with hypertensive disorders of pregnancy in a tertiary hospital in Ghana," Social Science & Medicine, Elsevier, vol. 289(C).

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