Immpact Toolkit: Module 4
Version 2
Perceptions of Quality of Care (PQOC)
One of the strategies identified as crucial for saving pregnant women's lives, and a good indicator of progress towards the reduction of maternal mortality, is skilled attendance at delivery, a key element of which is quality of care. Yet this potentially life-saving intervention has not been provided or taken up sufficiently in many countries to ensure adequate coverage. Factors related to both users and providers of health care have been identified as potential causes of this lack of uptake, but it is still necessary to study contextual factors contributing to the lack of use of skilled care at delivery in different settings in order to give decision-makers and other safe motherhood stakeholders the requisite knowledge to provide user-centred maternity services that will attract and maintain user interest at all stages of the reproductive cycle, including labour and delivery.
This research tool draws on an application of qualitative methods in the evaluations carried out by Immpact in Burkina Faso, Ghana and Indonesia in 2005-06. It is designed to generate data that will shed light on the quality of maternity care provision from two sides: the 'demand' side (users of services and the broader community) and the 'supply' side (providers of care). On the demand side, PQOC seeks to understand health-care-seeking behaviours, women's experiences of maternity care, and other factors likely to affect their use of skilled care at delivery, with the aim of providing evidence to inform the development of services that will be better able to facilitate increased community use of such care. On the supply side, PQOC seeks to understand maternity care practitioners' views on their own conditions of work and on the maternity care policy under evaluation. The sample instrument given here is focused on views of a fee exemption policy for maternity care in Ghana, but could be adapted to explore other types of programmatic intervention.
This tool provides step-by-step guidance in applying the PQOC approach. The qualitative methods that have been used are generic and the sample instruments can be adapted by users to their own context and specific requirements. Users of this tool should refer to more detailed guidance on the use of qualitative methods in Technical Annex B in Module 5, as well as the resources section in Technical Annex F, which also highlight where alternative methods could be used.