Do active patients seek higher quality prenatal care?: A panel data analysis from Nairobi, Kenya.
Despite poverty and limited access to health care, evidence is growing that patients in low-income countries are taking a more active role in their selection of health care providers. Urban areas such as Nairobi, Kenya offer a rich context for studying these "active" patients because of the large number of heterogeneous providers available. We use a unique panel dataset from 2015 in which 402 pregnant women from peri-urban (the "slums" of) Nairobi, Kenya were interviewed three times over the course of their pregnancy and delivery, allowing us to follow women's care decisions and their perceptions of the quality of care they received. We define active antenatal care (ANC) patients as those women who switch ANC providers and explore the prevalence, characteristics and care-seeking behavior of these patients. We analyze whether active ANC patients appear to be seeking out higher quality facilities and whether they are more satisfied with their care. Women in our sample visit over 150 different public and private ANC facilities. Active patients are more educated and more likely to have high risk pregnancies, but have otherwise similar characteristics to non-active patients. We find that active patients are increasingly likely to pay for private care (despite public care being free) and to receive a higher quality of care over the course of their pregnancy. We find that active patients appear more satisfied with their care over the course of pregnancy, as they are increasingly likely to choose to deliver at the facility providing their ANC.
Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. Electronic address: cohenj@hsph.harvard.edu.
Jessica
J
Cohen
Jacaranda Health, Kiamumbi off Kamiti Road, P.O. Box 52595, 00100 Nairobi, Kenya. Electronic address: gingermariegolub@gmail.com.
Ginger
G
Golub
Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. Electronic address: mkruk@hsph.harvard.edu.
Margaret E
ME
Kruk
Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA. Electronic address: mmcconne@hsph.harvard.edu.
Margaret
M
McConnell
D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
Active patient; Antenatal care; Kenya; Prenatal care; Quality of care
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