Service quality influences delivery decisions: A qualitative study on maternity care in rural Tanzania

BackgroundThe relationship between utilization of quality health services and positive health outcomes is well documented, however in low resource settings there is both a shortage of quality services and low utilization of existing services. We assessed women and men's understanding of quality in health facilities and their application of this understanding in selecting place of delivery.MethodsTen focus group discussions (FGD) were held between May and December 2011 (five with women and five with men). The groups had 6-11 respondents. FGDs were conducted, recorded, and transcribed in Swahili then translated into English. Transcripts were analyzed using NVivo 9 software. Conceptual framework confirmatory analysis was conducted to compare results from FGDs with pre-existing frameworks for understanding health center quality in low resource settings.ResultsHigh education and positive attitude of delivery staff, close proximity to the health facility, availability of providers, and modern equipment were cited as reasons for facility delivery. Expectations of complications and better care led to seeking care at higher-level institutions. The one aspect of quality that men focused on more than women was disrespectful care and health worker attitude. The choice to deliver in a hospital versus a primary care clinic or at home was not always the woman's - it was greatly influenced by providers, the husband and the mother-in-law.ConclusionsThese results suggest that quality improvement efforts should focus on both technical and nontechnical aspects of care and target not just women, but those who influence their choice of delivery location.Trial registrationISRCTN17107760.