Effect of facility readiness and providers’ adherence to standard clinical practices on women’s choice to deliver in public or private health facilities in Nepal

Tuladhar, Sabita (2025): Effect of facility readiness and providers’ adherence to standard clinical practices on women’s choice to deliver in public or private health facilities in Nepal. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background: The Maternal Mortality Ratio (MMR) of Nepal was 151 deaths per 100,000 live births in 2021, indicating the need for accelerating efforts to meet the Sustainable Development Goal (SDG) of 70 deaths per 100,000 live births by 2030. Health facility (HF) deliveries are increasing in Nepal, and so are the maternal deaths at HFs, indicating sub-optimal quality of delivery care services at HFs. This study aimed to understand the status of HF readiness for providing normal low-risk delivery services, the functionality of basic and comprehensive emergency obstetric and neonatal care (B/CEmONC) services, providers' adherence to standards of care during delivery care provision, and determinants of women’s satisfaction with normal low-risk delivery services. Methods: Publicly available data from the Nepal Health Facility Survey 2015 and 2021 was used. Data of 457 HFs in 2015 and 804 in 2021 for readiness; 47 B/CEmONC HFs in 2015 and 95 in 2021 for functionality; and 320 women in 2021 for adherence to standards of care and determinants of women’s satisfaction were analysed. Weighted t-tests compared changes in HF readiness and B/CEmONC functionality over time; principal component analysis constructed satisfaction variables; and multivariate logistic regressions analysed determinants of women’s satisfaction. Results: The HF readiness index improved significantly from 37.9% in 2015 to 43.7% in 2021, with private HFs performing slightly better than public HFs. The functionality of B/CEmONC signal functions in the designated HFs were low. Compliance with the standards of delivery care varied largely across different indicators. Provider-client interaction, audio-visual privacy, and the display of health statistics were associated with higher satisfaction levels. The availability of maternity waiting rooms and education materials and the implementation of the Maternity Incentive Scheme were associated with lower satisfaction levels. Conclusion: To meet the SDG of MMR reduction, Nepal needs to improve quality of care by strengthening the supply chain system, ensuring trained providers, increasing the use of guidelines, supporting private HFs, promoting provider-client interaction, and addressing the operational challenges of the Maternity Incentive Scheme.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Maternal mortality, quality of care, health facility readiness, standards of care, satisfaction, public-private, satisfaction, Nepal
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 6. März 2025
• 1. Bericht­erstatter:in: Siebeck, Matthias