Utilization and quality: How the quality of care influences demand for obstetric care in Nigeria

PLoS One. 2019 Feb 7;14(2):e0211500. doi: 10.1371/journal.pone.0211500. eCollection 2019.

Abstract

This paper examines the association between health facility quality, subjective perceptions, and utilization of obstetric care. We draw on unique survey data from Nigeria describing the quality of care at rural primary health care facilities and the utilization of obstetric care by households in the service areas of these facilities. Constructing a quality index using the detailed survey data, we show that facility quality is positively related to perceptions of quality and utilization. Disaggregating quality into structural, process and outcome dimensions, we find a consistently strong relationship only between utilization and structural measures of quality. The results suggest that efforts to improve quality may involve a trade-off between investing in dimensions that are more easily observed by households, which will influence utilization, and investing in dimensions that are more closely related to outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Humans
  • Nigeria
  • Obstetrics / statistics & numerical data*
  • Pregnancy
  • Prenatal Care / statistics & numerical data
  • Quality of Health Care*
  • Rural Population / statistics & numerical data
  • Young Adult

Grants and funding

RAND Corporation is a non-profit research organization and did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript and only provided financial support in the form of the author’s (EO and EP) salaries and research materials. Funding for the survey used in this paper was provided by the International Initiative for Impact Evaluation (3ie) through Grant No. OW4/1225. EO received the award. The funder provided support in the form of salaries for authors (EO), but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘Author Contributions’ section.