Mother's satisfaction with delivery services and strategies for improvement of delivery services at Tribhuvan University Teaching Hospital in Nepal

Abstract

Objective: To study the mother's satisfaction with delivery services indifferent locations of care in relation to doctor care, nursing care and servicefacilities and formulate strategic issues to improve the delivery services in theTribhuvan University Teaching Hospital and increase satisfaction of mothers. Design: A cross sectional descriptive study design. Setting: Tribhuvan University Teaching Hospital Maternity Ward. Subjects: Mothers who delivered in the TUTH during the survey period. Hospitalstaff in three groups nurses, doctors and management team. A total of 339 subjectswere randomly selected with eligibility criteria. Method: The study is quantitative as well as qualitative. A structuredinterview questionnaire was use for data collection of mothers who delivered in thehospital for the satisfaction ratings during May to August 1998. Focus groupdiscussion sessions were conducted with hospital staff in three groups to collectinformation about formulation of strategic issues for improvement of deliveryservices. Results: The background characteristics results show that the mean age ofrespondents is 23.49 years. The education status are 16.2% illiterate, 38.1%secondary school, 30.7% college and rest are other categories. Employment status are72.2% housewives and farmers and 27.8% are service holders. Median monthly familyincome is Rs 5000. Likewise obstetric data shows 49% primi para, 89.1% had antenatalcare visit and 59.6% are the normal delivery. The proportion of mothers stisfied with overall delivery services is 96.5%.However separate scale analysis of three dimensions of delivery services are slightlydifferent. There are 86.7% satisfied in doctor care dimension, 92.9% satisfied innursing care dimension and 87.9% in service facility. The statistically significant association found at alpha level 0.05 when x('2) testwas performed in two by two contingency table in the satisfaction dimension andbackground characteristic variables. Such as satisfaction with doctor care dimensionand parity of mothers at p=0.016 where multi parus mothers are more satisfied thanprimi paras. Similarly satisfaction in nursing care and monthly family income showedassociation at p=0.048 where less income category are satisfied than more incomecategory. The qualitative data revealed strategies for improvement as prompt need toimprove sanitation facilities, increase beds and staff number, additional supply ofinstruments, initiate patient orientation and staff development activities and obtainautonomy in decision making etc.