Spatial Differences in Quality of Maternal Health Service in Primary Health Centers of Enugu State, Nigeria

Aim: The aim of the study was to determine how adequate were the resources, (equipment and personnel), process (client-provider interaction), and outcome components of quality of maternal health service in urban and rural primary health centers of Enugu state, Nigeria.

Study Design: Cross-sectional analytical study design.

Place and Duration of Study: Primary health centers in Enugu State, Nigeria, between January and March 2013.

Methodology: A three stage sampling method was used to select 540 clients in18 of 440 primary health centers in the state. The clients were women who attended antenatal and postnatal care in the health centers. Outcome measure was clients true satisfaction with maternal health service also denoted as satisfaction index. It was assessed by proportion of clients who were satisfied with antenatal, and postnatal care, were ready to use the health centers again, and willing to recommend them to others for same services.

Results: No health center had adequate equipment, 16.7% of health centers had adequate health manpower and 16.7% had good client provider interaction. Only a minor proportion of clients, (urban 7%; rural 24.1%) delivered in the health centers. On part of clients, 64.8% in urban were truly satisfied, as compared to 75.6% in rural. Predictors of clients true satisfaction included being a client in urban, (AOR=0.6, 95% CI: 0.4- 0.9), client unmarried, (AOR=0.3, 95% CI: 0.1- 0.5), and being unemployed/housewife, (AOR=2.0, 95% CI: 1.3- 4.5).

Conclusion: The structure and process components of quality of maternal health service in primary health centers in the study area were deficient. Also, utilization of health centers for delivery services was poor. The clients of maternal health service seem to focus more on providers of healthcare and their interactions with them than the health system and its deficiencies hence were easily satisfied with the services received. To reduce the maternal death burden in Nigeria there is need for adequate attention on rural areas, the primary health care system and the provision of client oriented health services at all levels of care. More health workers should be employed, and more equipment supplied in-order to improve the quality of maternal health service in the primary health centers.