Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction
Health Affairs, March 2016 vol. 35 no. 3 510-519, doi:10.1377/hlthaff.2015.0902
Margaret E. Kruk, Daniel Vail, Katherine Austin-Evelyn, Lynn Atuyambe, Dana Greeson, Karen Ann Grépin, Simon P. S. Kibira, Mubiana Macwan’gi, Tsitsi B. Masvawure, Miriam Rabkin, Emma Sacks, Joseph Simbaya and Sandro Galea
Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients’ receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers’ knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers’ clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers’ knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program.