The quality of care a patient receives when giving birth is influenced substantially more by the facility in which she receives care than by the provider who provides the care, according to original research conducted by Surgo Foundation and published in the latest edition of BMJ Global Health.
“Our research has important implications for efforts to reduce maternal and infant mortality in low- and middle income countries,” said Dr. Sema Sgaier, executive director of Surgo Foundation and Adjunct Assistant Professor at the Harvard T.H. Chan School of Public Health. “It suggests that instead of designing interventions that focus primarily on shifting the behavior of healthcare providers, we should design interventions that focus on the culture and characteristics of the facility as a whole.”
Considering that half of all maternal deaths and one million newborn deaths each year are due to poor quality healthcare, scientists from Surgo Foundation set out to explore how much of an influence care providers, medical facilities, and countries have on pregnant women’s quality of care during labor and delivery.
The team looked at a set of vital signs-related data gathered from women arriving at facilities to deliver a baby in Uttar Pradesh, India. They compared this data with observations of labor and delivery visits in facilities in Kenya and Malawi, including the labor and delivery itself, and care during the immediate postpartum period. Their key finding: not only is the quality of care a patient receives influenced more by facility than health care provider, but this is true even for aspects of care that do not require specialized training or equipment.
Read Surgo’s paper, “Facilities are substantially more influential than care providers in the quality of delivery care received: A variance decomposition and clustering analysis in Kenya, Malawi and India,” in the August 2020 edition of BMJ Global Health.