Effects of combined decision-support and performance-based incentives on reported client satisfaction with maternal health services in primary facilities: A quasi-experimental study in the Upper East Region of Ghana

Abstract

Background Computerized decision-support systems (CDSS) and performance-based incentives (PBIs) have potential to contribute to client satisfaction with health services. However, rigorous evidence is lacking on the effectiveness of these strategies in lower-income countries such as Ghana. This study aimed to determine the effect of a combined CDSS-PBI intervention on client satisfaction with maternal health services in primary facilities in the Upper East Region of Ghana. Methods We employed a quasi-experimental controlled baseline and endline design to assess the effect of the combined interventions on client satisfaction with maternal health services, measured by quantitative pre/post-test client satisfaction survey. Our analysis used difference-in-difference logistic regression, controlling for potential covariates, to compare variables across intervention and comparison facilities at baseline and endline. Results The combined CDSS-PBI intervention was associated with increased or unchanged client satisfaction with all maternal health services compared at endline. Antenatal client difference-in-difference of mean satisfaction scores were significant at endline for intervention (n = 378) and comparison (n = 362) healthcare facilities for overall satisfaction (DiD 0.058, p = 0.014), perception of providers’ technical performance (DiD = 0.142; p = 0.006), client-provider interaction (DiD = 0.152; p = 0.001), and provider availability (DiD = 0.173; p = 0.001). Delivery client difference-in-difference of satisfaction scores were significant at endline for intervention (n = 318) and comparison (n = 240) healthcare facilities for overall satisfaction with delivery services (DiD = 0.072; p = 0.02) and client-provider interaction (DiD = 0.146; p = 0.02). However, mean overall satisfaction actually reduced slightly in intervention facilities, while DiD for technical performance and provider availability were not significant. Conclusion This combined CDSS-PBI intervention was associated with greater antenatal and delivery client satisfaction with some aspects of maternity services within two years of implementation. It could be expanded elsewhere if funds allow, though further research is still required to assess cost-effectiveness and long-term effects on client satisfaction and maternal health outcomes.

The Association Between Pregnancy-Related Factors and Health Status Before and After Childbirth With Satisfaction With Skilled Delivery in Multiple Dimensions Among Postpartum Mothers in the Akatsi South District, Ghana

“…Another justification for these disparities in the results could be that the quality of services rendered in various countries and within countries from one setting to another setting might inform the measurement of satisfaction using different methods. Similar studies conducted in Nepal, Nigeria, the Netherlands, Ghana, and Australia assessed patient satisfaction in several dimensions, but the overall satisfaction scores were not calculated (7,(10)(11)(12)21). The discrepancy could be due to the availability of services rendered in our study setting compared to those in previous studies.…”

“…The satisfaction of postpartum mothers is the measure of their desired expectations, intentions, preferences, and experiences from skilled delivery (7,8,10,11). Skilled delivery is a service provided in a structured facility by a certified health worker who has been trained to be proficient in the services required to improve the lives of expectant mothers during labor and the postpartum period (2,12). Approximately 69-73% of maternal and neonatal mortalities could have been prevented among mothers if skilled delivery was made available and accompanied by satisfaction (2).…”

“…Understanding the factors associated with the satisfaction of postpartum mothers is essential to provide standard skilled delivery in healthcare facilities (8,13). The services provided in health facilities at the maternity department are essential to improving maternal and neonatal health to prevent mortality and morbidity due to complications from conception to childbirth (2,12,14).…”

“…Studies have found inadequate health professionals, inappropriate prognoses and therapeutics, inadequate needed capital, poor referral systems, preference of skilled personnel, and previous exposure to complications as health system barriers that affect skilled delivery to mothers (2,5,12,(15)(16)(17). Satisfaction of patients with skilled delivery has been reported to be associated with sociodemographic factors (Figure 1) (1, 4, 7-9, 14, 18, 19), long waiting time (4,14,19), treatment outcome (2,(18)(19)(20), availability, and preference of healthcare providers (2,4).…”

“…The experience of having psychiatric illness has been a reported cause of emotional disorders from pregnancy to the postpartum period that affect satisfaction (22). In addition, the mother's health status before and after childbirth may be affected by factors related to pregnancy, infant health, and non-medical factors, such as sociodemographic characteristics (6,9,12,21,22). Many studies have assessed patient satisfaction as a general outcome (4,5,9,18,19,23,24), and others have assessed various dimensions with reported different satisfaction levels (general satisfaction, technical quality, communication, financial, responsiveness, and accessibility) (1, 3, 7, 10-12, 14, 16, 21, 25).…”