Abstract
BACKGROUND: The maternal mortality rate in Lao PDR (Laos) is still the highest in Southeast Asia, at 197 per 100,000 live births. Antenatal care (ANC) could contribute to maternal and child mortality reduction. The quality of ANC service remains inadequate and little information is available on the quality of health education and counseling services of health providers in Laos. This study aims to gain insight into the perceptions of stakeholders on both supply and demand sides of public ANC services in Laos and evidence for recommendations to improve the quality of ANC services.
METHODS: Semi-structured interviews were conducted with 50 participants from different stakeholder groups; on the demand side, couples with a currently pregnant woman and mothers with children under one year of age and a family member; and on the supply side, health providers, managers, policy makers of the Ministry of Health, and development partners. The interviews were voice recorded and transcribed verbatim for analysis by open and thematic coding, using the MAXQDA software program.
RESULTS: All respondents reported that the number of pregnant women who visit ANC services has increased. However, an analysis of the supply side identified issues related to the quality of ANC that need to be improved in the areas of facilities, human resources, privacy and confidentiality, providers' behavior, attitudes, and ineffective communication skills when it comes to providing health education and counseling to pregnant women and their family members. The analysis of the demand side mainly emphasized the issues of providers' behavior, attitude, communication and unequal treatment, and the lack of privacy. Both sides also suggested solutions to the problems, such as training, effective materials, rewarding good role models, and building a feedback system.
CONCLUSION: The number of public ANC services has increased, but both supply and demand sides experienced challenges with the quality of ANC. All respondents proposed possible solutions to improve quality of ANC service in public health facilities in Laos.
| Original language | English |
|---|---|
| Article number | 255 |
| Pages (from-to) | 1-13 |
| Number of pages | 13 |
| Journal | BMC Pregnancy and Childbirth |
| Volume | 19 |
| DOIs | |
| Publication status | Published - 22 Jul 2019 |
Funding
* Correspondence: [email protected] 1Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Samsenthai Street, Pearvath Village, Sisathanark District, Vientiane Capital, Lao PDRP.O. Box: 7444 Full list of author information is available at the end of the article ANC: Antenatal Care; DHS: Demographic Household Survey; IEC: Information Education and Communication; Lao PDR: Lao People’s Democratic Republic; LMIC: Low-and Middle-Income Countries; MCNV: Medical Council Netherlands Vietnam; MMR: Maternal Mortality Rate; MOH: Ministry of Health; SOP: Standard Operation Procedure; SSI: Semi-structure Interview; UNFPA : United Nations Population Fund; UNICEF: United Nations International Children’s Emergency Fund; WHO: World Health Organization The authors would like to express our gratitude to the EU funded LEARN Project (Number: DCI/SANTI/2014/342-306) and MCNV in Laos for financial support. We would like to give special thanks Dr. Phouthone Vangkonevilay, Dr. Somchit Boupha, Dr. Bounthom Samountry, Dr. Sengchanh Kounnavong, Dr. Vanphanom Sychareune, Dr. Alongkone Phengsavanh, Dr. Visanou Hansana, Mr. Ian Bromage, Mr. Stephen Himley, and Ms. Suzanna Lipscombe for their kind support and encouragement including my family members. In addition, we would like to thank our research assistants from the University of Health Sciences, Laos who contributed their best effort to collect data for this study. We also would like to express our sincere thanks to Salavan and Attapeu provincial and district health departments for their excellent collaboration in the fieldwork. Finally we would like to give our heartfelt thanks to all key informants at the central, district, and community levels for sharing their valuable time and information to participate in this study. 1Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Samsenthai Street, Pearvath Village, Sisathanark District, Vientiane Capital, Lao PDRP.O. Box: 7444. 2Vrije Universiteit Amsterdam, Athena Institute and Amsterdam Public Health Institute, Amsterdam, The Netherlands. 3Guelph International Health Consulting, Amsterdam, The Netherlands. 4Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. 5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| Funders | Funder number |
|---|---|
| MCNV in Laos | |
| European Commission | DCI/SANTI/2014/342-306 |
Keywords
- Antenatal care (ANC)
- Laos
- Quality improvement
- Stakeholders' perspectives
- Supply and demand sides
