| dc.description.abstract | Evaluating the quality of healthcare delivery is an important policy and theoretical
concern. The expansion of the system's domain and the inclusion of both supply- and
demand-side considerations are two examples of the proposed frameworks that aim to
make the health system more responsive. Deficiencies in responsiveness are revealed
by secondary research in a variety of settings. This study evaluated the responsiveness
of childbirth services Murang'a County Referral Hospital (MCRH) to understand why
despite the implementation of a free maternity program, uptake of skilled birth
attendance remained relatively low. The study looked into both the overall quality of
maternal care services and contributing factors. This was done with four research
objectives; i) To determine the influence of access factors on responsiveness during
childbirth in MCRH ii) To establish the influence of maternal characteristics on
responsiveness during childbirth in MCRH iii) To determine the influence of structural
factors on responsiveness during childbirth in MCRH iv) To establish the influence of
the process of care factors on responsiveness during childbirth in MCRH. Using
quantitative data collection techniques, a descriptive approach was taken. Postnatal
women who gave birth at MCRH were given a structured questionnaire via systematic
random sampling. The data were analyzed using R software, with chi-square used to
test for associations and binary logistic regression used for multivariate analysis. Odds
ratios, confidence intervals, the total number of respondents, and percentages were
used to present the data. 88 (69%) of the 129 participants in the sample provided
comprehensive data for both variables. Many of the respondents had less than five
children, were single, young, married, and living in rural areas. The domains of dignity,
autonomy, and communication were highly rated, with room for improvement in the
confidentiality domain. Distance covered to get to the hospital (OR= 0.206 95% CI
0.053-0.801), costs of accessing care OR=0.159 95% CI 0.039-0.639), and the
provision of culturally respectful services (OR=0.07 95% CI 0.009-0.545) were found
to influence responsiveness. Marital status (OR: 11.958 95% CI 1.178-121.376),
commodity availability, adequacy of beds (P<0.005), and language use during labor
were also significant contributors. Overall, MCRH has responsive childbirth services.
However, the low utilization of skilled birth attendance may be attributed to distance
to the hospital, care costs, lack of supplies, inadequate beds, and language use during
labor. There is need for the county government to invest in the supply-side needs of
the health system to promote responsive childbirth services at MCRH. | en_US |
