Do mobile clinics provide high-quality antenatal care? A comparison of care delivery, knowledge outcomes and perception of quality of care between fixed and mobile clinics in central Haiti

Abstract

BackgroundAntenatal care (ANC) is an important health service for women in developing countries, with numerous proven benefits. Global coverage of ANC has steadily increased over the past 30 years, in part due to increased community-based outreach. However, commensurate improvements in health outcomes such as reductions in the prevalence of maternal anemia and infants born small-for-gestational age have not been achieved, even with increased coverage, indicating that quality of care may be inadequate. Mobile clinics are one community-based strategy used to further improve coverage of ANC, but their quality of care delivery has rarely been evaluated.MethodsTo determine the quality of care of ANC in central Haiti, we compared adherence to national guidelines between fixed and mobile clinics by performing direct observations of antenatal care consultations and exit interviews with recipients of care using a multi-stage random sampling procedure. Outcome variables were eight components of care, and women’s knowledge and perception of care quality.ResultsThere were significant differences in the predicted proportion or probability of recommended services for four of eight care components, including intake, laboratory examinations, infection control, and supplies, iron folic acid supplements and Tetanus Toxoid vaccine provided to women. These care components were more likely performed in fixed clinics, except for distribution of supplies, iron-folic acid supplements, and Tetanus Toxoid vaccine, more likely provided in mobile clinics. There were no differences between clinic type for the proportion of total physical exam procedures performed, health and communication messages delivered, provider communication or documentation. Women’s knowledge about educational topics was poor, but women perceived extremely high quality of care in both clinic models.ConclusionsAlthough adherence to guidelines differed by clinic type for half of the care components, both clinics had a low percentage of overall services delivered. Efforts to improve provider performance and quality are therefore needed in both models. Mobile clinics must deliver high-quality ANC to improve health and nutrition outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1546-7) contains supplementary material, which is available to authorized users.

Mobile clinics in humanitarian emergencies: a systematic review

“…1). Five papers (describing five distinct studies) met the inclusion criteria and were included in the synthesis; these are summarised in Table 1 [14][15][16][17][18]. Papers were screened out following full-text assessment owing to: a lack of empirical data, the paper reported on an out of scope modality, and/or the context was a non-humanitarian setting.…”

“…The five included studies reported on mobile clinic interventions focusing on non-communicable diseases [14], mental health [15], sexual and reproductive health [18], and multiple primary health services [16,17] in Afghanistan [17], the Democratic Republic of the Congo (DRC) [16], Haiti [15,18], and the Occupied Palestinian Territories (OPT) [14]. The study designs employed included: a quasiexperimental longitudinal study [14], two retrospective longitudinal studies [15,17], a cross-sectional survey [9], and one self-described 'case study' which includes some elements of programme evaluation [16].…”

“…Three studies included a qualitative component (e.g. qualitative interviews, exit interviews) [15, 16,18]. The quality of included studies was assessed as good [14,18], fair [16], and poor [15,17].…”

“…The five studies reported on four of the seven OECD-DAC evaluation criteria, namely relevance/appropriateness [14][15][16], coverage [15][16][17], efficiency [14,18], and effectiveness [14][15][16][17][18]. All five studies sought to assess effectiveness to some extent.…”

“…A comparative study of fixed and mobile clinics for providing antenatal care in Haiti Phillips et al (2017) compared the efficiency and effectiveness of antenatal care (ANC) between fixed and mobile clinics in Haiti as measured by eight components of care, as well as women's knowledge and perception of quality of care [18]. The Maternal and Child Health and Nutrition Program (MCHNP) provided free ANC and post-natal care, with the intention of increasing ANC coverage, via 130 mobile clinics in locations in the Central Plateau of Haiti with limited access to health services.…”