Quality of Care in Risk Pregnancy and Obstetric Emergency: in an Indigenous Population

Abstract

Introduction. To achieve the highest / the desired levels of quality in health services provided, all departments, whether they perform clinical or non-clinical roles, must work together. The following study will explore both the performance and employee satisfaction regarding resources and working conditions of health workers specifically providing services for patients experiencing high-risk pregnancies or obstetric emergencies. The  study was conducted with healthcare providers in southern Mexico who are primarily serving patients of indigenous backgrounds. Methods.This is an observational, cross-sectional study, conducted during 2017-2018 in medical units affiliated with the Integrated Health Services Networks (IHSN) subsidized by the federal government to serve vulnerable populations in the southern Mexican states of Oaxaca and Chiapas. A multiple choice questionnaire was administered to health personnel working in medical units. The sample of healthcare workers was intentionally nonprobabilistic (n=30 Chiapas, n=31 Oaxaca). The conditions of obstetric healthcare provision were contrasted by assessing differences by state (Fisher’s exact test). Healthcare workers’ satisfaction with the medical organization and resources available for each medical units was also described. Results. The 62.1% of healthcare workers in Chiapas and 58.3% in Oaxaca reported that the quality of care being provided was the best possible with the existing resources and infrastructure. This being said, fewer than half of the participants believe that high-risk pregnancy cases were followed up correctly, or that users were discharged in a timely manner. In response to the satisfaction items on the questionnaire, more than half of the providers marked “not always” satisfied with the resources or organization of their medical facility which are needed in treating high-risk pregnancies or obstetric emergencies. Their responses addressed three main issues: the existing equipment in the units or lack thereof, the maintenance of that equipment, and the availability of medical supplies. Fewer than 10% felt satisfied with these. Conclusions. The opinion of direct healthcare providers is crucial to improving quality in resource-scarce environments in low- and middle-income countries such as Mexico. In particular, it is important to hear from staff who are experiencing low job satisfaction as well as low-resources within the infrastructure of rural hospitals and clinics dedicated to treating high-risk pregnancies and obstetric emergencies. Recognizing and addressing these issues should create a more supportive environment and subsequently avoid other, less adverse health outcomes for the women being treated.