Abstract:
Background Measures of quality of care in low- and middle-income
countries (LMICs) rarely include experience of care. This gap in service
quality metrics may be driven by a lack of understanding of client and
provider perspectives. Understanding these perspectives is a critical first
step in not only improving metrics, but also in improving service delivery.
This study identifies the items antenatal care (ANC) clients and
health care providers in Tanzania associate with a quality ANC service
and explores the experience of care domain from both client and provider
perspectives.
Methods We conducted semi-structured interviews with15 providers and
35 clients in Tanzania that included a free-listing activity to elicit items
clients and providers associate with quality ANC services. We analyzed
the free-listing for rank order and frequency to identify the most salient
items, which were included in the second phase of data collection. We
then conducted semi-structured interviews with a pile sort activity with
the same 15 providers and 32 new clients to understand the importance
of the items identified in the free-listing. We used a thematic analysis driven
by the framework approach to analyze interview data.
Results Both clients and providers perceived quality of ANC as being
comprised of items related to experience of care, provision of care, and
cross-cutting essential physical and human resources. The free-listing
findings illuminated that the experience of care was equally important to
clients and providers as the availability of physical and human resources
and the content of the care delivered. In addition, clients and providers
perceived that a positive patient care experience – marked by good communication,
active listening, keeping confidentiality, and being spoken
to politely – increased utilization of health services and improved health
outcomes.
Conclusions The experience of care in LMICs is an overlooked, yet critically
important topic. Understanding the experience of care from those
who receive and deliver services is key to measuring and improving the
quality of ANC. Our research highlights the importance of incorporating
experience of care into future quality improvement activities and quality
measures. By doing so, we identify barriers and facilitating factors of
practical use to policy-makers and governments in LMICs.
