Evaluation of quality of prevention of mother to child transmission of hiv (pmtct) option b+service; the case of government health facilities of jimma town, south west, Ethiopia

Abstract

Background: Worldwide, an estimated 240,000 children were become newly Human Immunodeficiency Virus (HIV) infected in 2013. The main source of HIV infection in children is vertical transmission of HIV from mother-to-child during pregnancy, labor and delivery, or breastfeeding. Number of health facilities providing Prevention of Mother-to-Child Transmission of HIV service has increased throughout Ethiopia. However, published studies on services’ provision in country are generally limited; even fewer studies do examine quality of the services. Evaluation objective: The main objective of the evaluation was to evaluate the quality of prevention of mother to child transmission of HIV (PMTCT) option B+ service in Jimma town government health facilities, 2016. Method and Materials: Case study design involving both quantitative and qualitative methods was conducted in Jimma town government health facilities in March 2016. The focus of this evaluation was on the process of Prevention of Motherto-Child Transmission of HIV option B+ service. A total of 292 pregnant women were interviewed and Six months record of Antenatal Care (ANC), PMTCT and delivery registers and reports were reviewed. Service provision processes were observed for 27 counseling sessions. Moreover, key informant interview was conducted with six heads of health facilities, six health care providers working at ANC/PMTCT and one program manager of town health office. Additionally, facility audit was done. Donabedian’s Structure-Process-Outcome model was used to assess the quality of program service at respective study area. Data was analyzed using SPSS for windows version 20 software. Univariate analysis was conducted to see the frequency, proportion and mean of variables for descriptive findings. Binary and multivariate logistic regressions analyses were computed to see the predictors for satisfaction of clients on quality of service. Qualitative data were transcribed, summarized in to major thematic areas to complement the quantitative findings. The evaluation findings were interpreted based on pre-determined judgment matrix. Result: Most of the minimum required resources such as ARV drugs, registers, report formats, separate room and other supplies were available. However, inadequate of trained human resource was observed. Also frequent stock out of test kits were observed as a resulting to missing of services among partners. On average availability of resources for program (84%) and compliance of health care providers (85.1%) were judged to be requiring improvement. Moreover, there was repeatedly missing some important components in the counseling manual during both pre-test and post-test counseling sessions. But, acceptability dimension (85.5%) was judged as acceptable and client satisfaction on PMTCT option B+ service was, about 94.2% of them were either satisfied or very satisfied. Overall quality of PMTCT option B+ service was acceptable. Clients’ satisfaction with PMTCT option B+ services was found to be associated with travel time (AOR= 0.16, 95% CI (0.035, 0.706), p-value<0.016), consultation time (AOR = 3.34, 95% CI (1.59, 7.2), p-value<0.002) and marital status of clients (AOR= 0.066, 95% CI (0.01, 0.42), p-value<0.004). Conclusion: Although the level of satisfaction with service provision was very high and overall quality of service was acceptable, availability of necessary resource and compliance of health care providers to national guideline need improvement. We recommend more efforts to be exerted on improving providers’ compliance, availing of necessary resources to enhance the status of PMTCT services.