Exploring Private Health Providers’ Perception of Challenges and Opportunities in Providing Quality Maternal and Neonatal Services in Uganda.

Abstract

In Uganda, neonatal and maternal mortality rates remain high despite modest improvements in the last decade. Public health officials often believe these mortality rates can be best improved by improving access and quality of care in public health facilities, but many Ugandans visit private providers due to ease of access to care and perceptions of better quality services. Few studies have examined provider perceptions of the delivery of quality maternal and neonatal care in private facilities in Uganda, especially in lower level private facilities. The objective of this study was to explore the administrative, contextual, and clinical challenges and opportunities in providing perceived quality obstetric and neonatal care services in private health facilities in Masaka and Jinja districts in Uganda. This descriptive qualitative study included 5 focus group discussions and 20 in-depth interviews with 27 staff from 7 private facilities that had all participated in trainings by Life-Net International, an organization that provides onsite medical and administrative training. The study participants were midwives, clinical officers, nurses, nursing assistants, a laboratory attendant and a cashier. Descriptive qualitative analysis was conducted using data-driven codes for the transcribed texts. Data were coded using NVivo software version 11 and coded segments were reviewed and themes developed, which were then categorized into domains. Our main finding is that 1) private lower level providers were not confident in their clinical skills capacity to provide quality neonatal and maternal care and 2) training is one piece of strengthening these systems and yet private lower level providers may have less access to training. The factors reported to affect provision of quality maternal and neonatal care emerged in the following 6 domains: 1) health center supplies and equipment; 2) health center human resources; 3) health center record-keeping and data management; 4) facility connection to the health system; 5) in-clinic patient care at pre-natal, labor, birth and post-natal care; and 6) Life-Net training experiences. These factors are similar to those reported in the literature on public facilities, but private sector providers reported having less access to training opportunities. Further, clinical practice as reported was not consistent with government guidelines and World Health Organization standards for a low-level facility. To improve neonatal and maternal care in Uganda, both public and private facilities need to be robust. There is an urgent need to invest in private facilities, provide training programs and hear more from private lower level providers.