Health Quality and Outcomes

Objectives

The overall objective of this WP is to determine the impact and effectiveness of user fee removal on maternal and neonatal morbidity and quality and uptake of emergency obstetric care, using a generic approach that it is easily adaptable to other programmes aimed at improving timely access to emergency care. This generic approach will be centred on the concept of near-miss events and will use hospital-based information. Specific objectives include:

  1. To determine whether user fee removal has the intended effect of increasing timely and equitable access to emergency obstetric care. This will be done by :
  • setting up a system capturing near miss events in selected hospitals, with a particular focus on maternal and neonatal complications
  • comparing the incidence and patterns of maternal and neonatal near-miss-upon-arrival in districts with well and poorly performing fee removal programmes, and by socio-economic status of the women
  • conducting in-depth interviews with women who have received emergency care for near miss, and their family members, to help understand the role of financial barriers relative to other factors in ensuring timely access to emergency obstetric care, and to help understand healthcare users’ views on the relationship between healthcare costs and access

2. To determine the intended and unintended effects of user fee removal on quality of care in women admitted with near-miss. This will be done by:

  • comparing indicators of quality of care in women admitted with near-miss in well and poorly performing hospitals, including near-miss after admission, delays and adverse events indicators (such as medical errors or “health care near-miss”)
  • conducting comparative observations of maternity care in well and poorly performing hospitals
  • conducting in-depth interviews with women admitted with near-miss and their caretakers to understand their perceptions of quality of care, the role of financial barriers in determining perceived quality of care and any unintended effects of removal of user fees on healthcare users’ experiences in the health facility
  • using the lessons learnt to improve performance in hospitals in the settings where we work, and to draw lessons for similar programmes in other settings

3. To determine whether user fee removal has the effect of increasing equitable access to skilled delivery care and caesarean sections in general. This will be done by analysing secondary data from large scale surveys

The findings from the FEMHealth project have now been finalised. Click here to see the reports and policy briefs produced by the consortium.