Population Council Research that makes a difference

Abstract

Quality of care in private and public facilities: Making childbirth cherished and safe for women in Bangladesh 
Presentation at the American Public Health Association 139th Annual Meeting and Exposition, 30 October
Rahman,Laila; Rob,Ubaidur; Talukder,Md.Noorunnabi; Hena,Ismat Ara
Publication date: 2011


Purpose
The 2010 Bangladesh maternal mortality survey surprisingly revealed the private sector's significant contribution in providing maternal health services. Quality of care is pivotal for making childbirth safe and joyful, but the quality of services within the private sector remains largely unknown. Therefore, this paper compares quality of care between public and private facilities where public establishments had historically been the major institutional provider.

Data
The sample constituted 511 females who delivered in the facilities last year. The sample was drawn using systematic random sampling from 16 upazilas in 2010.

Methods
Descriptive statistics and logistic regression using SPSS 14.0 were used. Binary outcomes of the dependent variable included satisfaction and nonsatisfaction in receiving delivery care.

Results
Almost half of the women delivered in private facilities. Waiting time did not vary, but providers were friendlier (?² [1, N = 508] = 7.09, p =.01), more attentive (?² [2, N = 506] = 13.10, p =.00), explained elaborately (?² [2, N = 502] = 15.64, p =.00), maintained privacy (?² [2, N = 506] = 27.85, p =.00), and carried out more physical examinations in private than public facilities. Logistic regression model, controlling for age and location, revealed that women were 4.82 times (95% CI, 2.96-7.84) more likely to be satisfied with the private than public facilities.

Recommendations
Childbirth should be cherished, and exceed mere survival. Private facilities are to be encouraged although there are scopes for improvement. Not to waste the huge infrastructure, public facilities need to significantly improve quality of care through training, monitoring, mentoring, and incentive-based payment for providers.