title: Evaluation Of A Maternal Health Program In Uganda And Zambia Finds Mixed Results On Quality Of Care And Satisfaction.
abstract: Saving Mothers, Giving Life is a multidonor program designed to reduce maternal mortality in Uganda and Zambia. We used a quasi-random research design to evaluate its effects on provider obstetric knowledge, clinical confidence, and job satisfaction, and on patients' receipt of services, perceived quality, and satisfaction. Study participants were 1,267 health workers and 2,488 female patients. Providers' knowledge was significantly higher in Ugandan and Zambian intervention districts than in comparison districts, and in Uganda there were similar positive differences for providers' clinical confidence and job satisfaction. Patients in Ugandan intervention facilities were more likely to give high ratings for equipment availability, providers' knowledge and communication skills, and care quality, among other factors, than patients in comparison facilities. There were fewer differences between Zambian intervention and comparison facilities. Country differences likely reflect differing intensity of program implementation and the more favorable geography of intervention districts in Uganda than in Zambia. National investments in the health system and provider training and the identification of intervention components most associated with improved performance will be required for scaling up and sustaining the program.
authors.affiliation: Margaret E. Kruk (mkruk@hsph.harvard.edu) is an associate professor of global health in the Harvard T.H. Chan School of Public Health, in Boston, Massachusetts.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
authors.affiliation: Daniel Vail is a student at the Stanford University School of Medicine, in California.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vail
authors.affiliation: Katherine Austin-Evelyn is a program officer for learning and evaluation at the International Women's Health Coalition, in New York City.
authors.forename: Katherine
authors.initials: K
authors.lastname: Austin-Evelyn
authors.affiliation: Lynn Atuyambe is an assistant professor of public health in the Department of Community Health and Behavioural Science, College of Health Sciences, Makerere University, in Kampala, Uganda.
authors.forename: Lynn
authors.initials: L
authors.lastname: Atuyambe
authors.affiliation: Dana Greeson is an Association of Schools and Programs of Public Health (ASPPH) Global Health Fellow at the US Centers for Disease Control and Prevention, in Pretoria, South Africa.
authors.forename: Dana
authors.initials: D
authors.lastname: Greeson
authors.affiliation: Karen Ann Grépin is an assistant professor of global health policy at the Robert F. Wagner Graduate School of Public Service, New York University, in New York City.
authors.forename: Karen Ann
authors.initials: KA
authors.lastname: Grépin
authors.affiliation: Simon P. S. Kibira is an assistant lecturer in the Department of Community Health and Behavioural Science, College of Health Sciences, Makerere University.
authors.forename: Simon P S
authors.initials: SP
authors.lastname: Kibira
authors.affiliation: Mubiana Macwan'gi is director of the Institute of Economic and Social Research, University of Zambia, in Lusaka.
authors.forename: Mubiana
authors.initials: M
authors.lastname: Macwan'gi
authors.affiliation: Tsitsi B. Masvawure is a visiting lecturer in the Department of Sociology and Anthropology, College of the Holy Cross, in Worcester, Massachusetts.
authors.forename: Tsitsi B
authors.initials: TB
authors.lastname: Masvawure
authors.affiliation: Miriam Rabkin is an associate professor of medicine and epidemiology in ICAP, at the Columbia University Medical Center, in New York City.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rabkin
authors.affiliation: Emma Sacks is a community health and implementation research specialist at the Maternal and Child Survival Program of the US Agency for International Development, and at ICF International, both in Washington, DC.
authors.forename: Emma
authors.initials: E
authors.lastname: Sacks
authors.affiliation: Joseph Simbaya is a research fellow at the Institute of Economic and Social Research, University of Zambia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Simbaya
authors.affiliation: Sandro Galea is dean of the Boston University School of Public Health, in Massachusetts.
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
mesh_terms: D000328:Adult; D000367:Age Factors; D003906:Developing Countries; D005260:Female; D006801:Humans; D016015:Logistic Models; D000068097:Maternal Health / Q000191:economics / Q000639:trends*; D008427:Maternal Health Services / Q000458:organization & administration*; D008428:Maternal Mortality / Q000639:trends*; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011247:Pregnancy; D011787:Quality of Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014454:Uganda; D055815:Young Adult; D015024:Zambia
keywords: Consumer Issues; Financing Health Care; Health Reform; Medicare; Organization and Delivery of Care