Authors: Kristine Nilsen*, WorldPop, University of Southampton, Zoe Matthews, Social Statistics & Demography, University of Southampton, Victor A Alegana, WorldPop, University of Southampton, Winfred Dotse-Gborgbortsi, Geography and Environment, University of Southampton, Andrew J Tatem, WorldPop, University of Southampton, Corrine W Ruktanonchai, WorldPop, University of Southampton, Carla Pezzulo, WorldPop, University of Southampton, Natatlia Tejedor Garavito, WorldPop, University of Southampton
Topics: Medical and Health Geography, Africa
Keywords: Universal coverage, quality of care, maternal health, geospatial analysis
Session Type: Paper
Universal coverage of births at health facilities including access to emergency obstetric care (EmOC) is at the centre of strategies aiming to reduce maternal mortality in low-income countries. Increases in health facility births have however not led to the expected large declines in maternal mortality suggesting poor quality of care. By combining health facility EmOC data and household survey data, this study assessed how the readiness of obstetric service environments influences the utilisation of births at health facilities in Ethiopia, Ghana, and Malawi- three countries at different stages on their path to universal coverage. The readiness of obstetric service environments was measured as follows. For each health facility, a quality index for obstetric services was calculated. Using a geospatial approach, health facilities were then linked to village clusters within a 10 km catchment area. Finally the quality score of each health facility within each catchment area was aggregated to obtain the obstetric environment readiness score. The effect of the readiness of obstetric service environments on the utilisation of births at health facilities was assessed through descriptive statistics and multi-level logistic models. Preliminary findings showed that obstetric service environments generally offered poor quality of care irrespective of utilisation levels supporting the supposition that quality can remain poor when coverage is high. While there was no association between obstetric readiness and utilisation in Malawi, significant positive effects were observed in Ghana and Ethiopia. These effects interacted with residential status or socioeconomic status suggesting that high levels of obstetric readiness benefited these groups.