QUALITY OF MATERNAL HEALTHCARE DELIVERY: Bar needs to be raised while utilisation is being achieved.

By: Salaudeen A I

From America to UK, China to India, Iran to Africa and back to Nigeria; factors like socioeconomic, socio-cultural, women education, inequality in healthcare accessibility, rural-urban dichotomy, level of household wealth and religion have been established as factors highly contributing to low utilization of maternal healthcare therefore contributing to high MMR most especially in Africa and some Asian countries. As expected, scholars have proferred efficiently effective solutions through their studies to mitigate effects of these factors on Maternal Mortality. The solutions ranging from abolishment of delivery fees as done in Kenya in 2013, effect of which was evaluated by a group of researchers - Gitobu et al (2018). The researchers reported a statistically significant increase in the number of facility-based deliveries with no significant change in the ratio of maternal mortality and the rate of neonatal mortality.

They concluded the result of their findings by suggesting that cost is a deterrent to healthcare facilities service utilization in Kenya and thus free delivery services are an important strategy to promote utilization of health facility delivery services; however, there is a need to simultaneously address other factors that contribute to pregnancy-related and neonatal deaths. Another intervention was the sensitisation of women and Media strategy in Egypt, the impact of the interventions as reported by Metwally, Ammal M., et al. (2020) was highly reflected on the percent of mothers who received care during their pregnancy period. Proper antenatal care at governmental or private health facilities was raised dramatically from 0.6 to 59.3% and those who utilized at least one family planning method from 61.4 to 74.4%. Accordingly, the rate of complications significantly reduced during pregnancy (38.1 to 15.1%), during delivery (24.1 to 13.1%) and during postpartum (81.7 to 7.0%). As an impact to the improvement, there was a marked reduction in adolescent pregnancy by 55% and better birth outcome with a reduction in the percent of stillbirth by 11.5%.

The work also concluded that it is important to provide a comprehensive package that works at both improving qualities of care as well as empowering women by knowledge to first aid measures.... China, after understanding the effect of marginalisation of rural areas on the access to maternal healthcare facilities, propagated a policy focusing facilities allocation in favour of rural communities, a policy which was as expected effective was reported to have significantly reduced rural maternal mortality, yet the work concluded that the government still needs to develop more equitable and flexible primary health care policies to narrow the imbalance in health resource allocation and pay more attention to the health care. Establishment of health schemes like NRHM and NHIS in India and Nigeria respectively were other intervention policies believed to increase the utilisation of maternal healthcare and healthcare in general. In a work done on implications of maternal mortality on socioeconomic development in Nigeria, Olonade, O., et al. (2019) also concluded that maternal mortality has debilitating effects on the socioeconomic development of any nation. It is therefore pertinent for the government to improve maternal health and eradicate poverty.... Also in a work done in Iraq, the researcher attributed poor healthcare services to high rate of maternal mortality, in their report Sadoon, Ahmed Thani, and Basim Hussein Bahir, (2020) said the evaluation revealed that the level of the overall practice of antenatal care services in PHCs was fair 78.6%. Poor postpartum care was provided in 92.9% of health care centers. Poor health care services for children were provided in 67.9% of health care centers. Fair level, for immunization activities in 67.9% of health care centers and poor level concerning the practice of health education services in 85.7% of health care centers. They therefore concluded that there is a shortage in the health care services provided for maternal and child at the MCH unit in the health care centers with high maternal and infant mortality rate....

It is clear in the above cited papers that all the interventions are practicable and effective as exponential increase in utilisation of maternal healtcare were empirically confirmed in the evaluation studies. Despite the increase in the healthcare utilisation reported in the studies, there were no significant reduction in maternal mortality rate, this quests make the papers concluded suggesting that quality healthcare services has to be ensured. It is therefore pertinent to systematically evaluate the maternal healthcare delivering system to understand the situation, hence profer lasting solution to improve the service delivery quality of the last block in the chain of reducing maternal mortality to the lowest rate.