Dear HIFA and CHIFA,
This review finds that 'Experience of care can be a stronger determining factor in MNCH-related decision-making than the quality of services provided.' Citation, abstract and a comment from me below.
CITATION: Strong J, Lattof SR, Maliqi B, Yaqub N. Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: A systematic review. BMC Health Services Research. 2021;21:1311
https://bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-021-...
ABSTRACT
BACKGROUND: Experience of care is a pillar of quality care; positive experiences are essential during health care encounters and integral to quality health service delivery. Yet, we lack synthesised knowledge of how private sector delivery of quality care affects experiences of care amongst mothers, newborns, and children. To fill this gap, we conducted a systematic review that examined quantitative, qualitative, and mixed-methods studies on the provision of maternal, newborn, and child health (MNCH) care by private providers in low- and middle-income countries (LMICs)...
RESULTS: Of the 139 studies included, 45 studies reported data on experience of care. Most studies reporting experience of care were conducted in India, Bangladesh, and Uganda. Experiences of private care amongst mothers, newborns, and children aligned with four components of quality of care: patient-centeredness, timeliness, effectiveness, and equity. Interpersonal relationships with health care workers were essential to experience of care, in particular staff friendliness, positive attitudes, and time spent with health care providers. Experience of care can be a stronger determining factor in MNCH-related decision-making than the quality of services provided. CONCLUSION: Positive experiences of care in private facilities can be linked more broadly to privileges of private care that allow for shorter waiting times and more provider time spent with mothers, newborns, and children. Little is known about experiences of private sector care amongst children.
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COMMENT (NPW): 'Experience of care can be a stronger determining factor in MNCH-related decision-making than the quality of services provided.' As we have discussed in depth on HIFA, it is problematic to compare patient experience with quality because patient experience is an essential *component* of quality. The other most important aspect of quality is of course health outcomes. The authors of this study discuss the real impact of patient experience on outcomes but concede that 'Given the heterogeneity between the studies in terms of study designs and interventions, it was not possible to conduct a meta-analysis for the outcome experience of care.' Users of services may put interpersonal relationships at #1, but if I were a patient or parent my first priority would be a healthcare professional who knows what s/he is doing.
In addition, it would be interesting to know the comparative health outcomes between private and public care in different countries.
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HIFA profile: Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
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