Changes in Service Availability, Readiness, Process of Care, and Client Satisfaction with Maternal Health Care Services: A Comparison between the 2015 and 2021 Nepal Health Facility Surveys (FA145) - Analysis Brief

Proper care during pregnancy and delivery, as well as the postpartum and postnatal periods, is essential for the health of women and newborns. The main objective of this comparison analysis is to assess the changes made in the maternal health services sector, particularly in antenatal care (ANC) and delivery services, between 2015 and 2021. The data for this analysis were drawn from the 2015 and 2021 Nepal Health Facility Surveys (NHFS). A simple additive index was used to produce scores by adding binary variables. The scores for service readiness, infection prevention and control, adherence to the process of care, and client satisfaction from 2015 and 2021 were compared to determine any notable differences. Overall, service availability and readiness for maternal health have significantly improved over the years. The availability of ANC services 5 or more days a week significantly increased from 85% of facilities in 2015 to 97% in 2021. However, only half of the facilities offered delivery services in both survey years, with no change between 2015 and 2021. The overall readiness scores for ANC increased significantly from 58% in 2015 to 63% in 2021, and the facility delivery service readiness score increased from 66% in 2015 to 72% in 2021. There was also a significant increase in all infection prevention and control-related items for ANC and delivery services between 2015 and 2021. Adherence to the process of care and ANC services showed little change between 2015 and 2021. The score for client history remained virtually unchanged and was relatively low. The score for physical examinations declined. However, there was significant improvement in testing capacity, from 35% in 2015 to 42% in 2021. The overall score for counseling and prescribing medicine showed only a modest increase. Client satisfaction with ANC services improved substantially in 2021. Nearly 9 in 10 of the clients were satisfied with ANC services available to them in 2021. The overall score for client satisfaction increased from 86% in 2015 to 89% in 2021. Specifically, the satisfaction with the amount of time spent waiting to see providers, the cleanliness of the facilities, the number of hours services are offered, the privacy offered, and the ability of health workers to discuss problems improved substantially in 2021. The COVID-19 pandemic may have contributed to some of the variabilities in quality of care from 2015 to 2021. The increased focus on infection prevention and control and the declines in adherence to the standards of physical examinations due to social distancing efforts may have contributed to these changes. However, average overall scores for both ANC and delivery readiness, as well as infection prevention and control, increased from 2015 to 2021, showing successful intervention in readiness to provide maternal health services. Most domains in the process of care showed improvement during this time, indicating success in current interventions, which should be continued. Client satisfaction levels have also improved, with the COVID-19 pandemic possibly contributing to the increase in satisfaction about the cleanliness of the facilities.