African countries facing conflict have higher levels of maternal mortality. Understanding the gaps in the utilization of high-quality maternal health care is essential to improving maternal survival in these states. Few studies have estimated the impact of conflict on the quality of health care. In this study, we estimated the impact of conflict on the quality of health care in Kenya, a country with multiple overlapping conflicts and significant disparities in maternal survival. Our study demonstrates the importance of designing maternal health policy based on the context-specific evidence on the mechanisms through which conflict affects health care. In Kenya, deterioration of equipment and infrastructure does not appear to be the main mechanism through which conflict has affected ANC quality. Further research should focus on better understanding the determinants of the gaps in process quality in conflict-affected settings, including provider motivation, competence, and incentives.
(World Health Organization, 2017-06) Kruk, Margaret E.; Chukwuma, Adanna; Mbaruku, Godfrey; Leslie, Hannah H.
Although substantial progress has been made in reducing child and maternal deaths in the past 15 years, many women and children in low- and middle-income countries continue to die of avertable causes. To stimulate a concerted effort to narrow the gap between rich and poor countries, the United Nation’s sustainable development goals (SDGs) include new targets to reduce maternal mortality to less than 70 per 100 000 live births and to reduce deaths of children younger than five years to 25 per 1000 live births by 2030. In this paper, we analyse the variation in the quality of processes of care in health facilities in seven countries in subSaharan Africa for two primary-care services: (i) antenatal care and (ii) care of sick children, using observations of clinical care, a gold standard measure of process quality. The results will inform policy-makers about current performance and provide a starting point for a broader discussion of quality measurement in the SDG era.
