Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review

Abstract

Background: Understanding the preferred choice of health service attributes for women is important particularly in sub-Saharan Africa (SSA) where resources are constrained and improving reproductive and maternal health services is of high importance. The aim of this review was to identify attributes of reproductive and maternal health services in SSA, and summarise the factors shaping women's preference to access these services.Methods: PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL were searched from inception of each database until March 2021 for published studies reporting stated preferences for maternal and reproductive health services in SSA. Data were extracted using a predefined extraction sheet, and the quality of reporting of included studies was assessed using PREFS and ISPOR checklits. The Donabedian's model for quality of healthcare was used to categorise attributes into "structure", "process" and "outcome".Results: A total of 13 studies (12 Discrete Choice Experiments and one Best-Worst-Scaling study) were included. Attributes related to structure of health services (e.g. availability of technical equipment, medications, or diagnostic facilities, having good system conditions) are often included within the studies, and are considered the most important by women. Of the three dimensions of quality of healthcare, outcome dimension was the least frequently studied across studies. All except one study explored women's preferences and the participants were pregnant women, women aged 18-49 years who had recently given births and women living with HIV. The included studies came from XX SSA countries of which Ethiopia and South Africa each contributed three studies. All of the included studies reported on the purpose, explanation, findings, and significance of the study. However, none of the studies reported on the differences between responders versus non-responders. Nine of the 13 studies employed ISPOR-checklist and reported each items including the research question, the methods for identifying and selecting attributes, and provided the findings in sufficient detail and clarity."Conclusions: Aligning maternal health service provision with women's preferences may foster clientoriented services and thereby improve service uptake and better patient outcomes.