Thesis:

A Thesis Submitted In Partial Fulfillment of the Requirement for the Award of Masters of Science Degree in Health Systems Management of Mount Kenya University

An effective medical intervention to prevent maternal morbidity and mortality is maternal health care (MHC). Therefore, quality of MHC is an important concern in addressing the challenges faced by Kenya as a country with high maternal mortality. This study assesses the influence of quality maternal healthcare service on client satisfaction in Rongai Sub-County health institutions. The study targeted all women of reproductive age (18-49 yrs.) seeking maternal health services in Rongai sub-county health facilities. The study adopted a descriptive cross-sectional design. The health care facilities were clustered according to administrative regions (wards) and the respective levels of care. That is, hospitals, health centers, and dispensaries, and simple random sampling were employed to choose the health facilities for the study. Convenience sampling was used to get 465 mothers, and purposive sampling method used to get healthcare practitioners in charge of the selected healthcare facilities. A questionnaire was administered to women searching for maternal healthcare services within Rongai Sub County to measure client satisfaction. An observational checklist was used to assess the facilities' ability to provide quality maternal health care as per WHO validated indicators for the provision of quality maternal medical care. An interview schedule was administered to the key informants (health care providers) to ascertain facilities' readiness to offer maternal healthcare. The data was analyzed descriptively (Means) and inferentially (Pearson Chi-Square) to test the relationship between the categorical variables and Spearman's correlation analysis to determine the co-relation between structural organization and items availability with clients' satisfaction. All the test was performed at 95% (P=0.05) level of significance. Through Pearson Chi-Square analysis, it was indicated that the level of education, employment status, income level and distance from the health facility are some of patients' related factors that influence their satisfaction with maternal health services (P value less than 0.05). It was also noted that referrals influenced the choice of facility the most and there was inadequate availability of some critical healthcare items in most facilities. Spearman's correlation analysis indicated that the need for adequate delivery services had the strongest and statistically significant correlation with client satisfaction (R= 0.998, P=0.003). This study concluded that the dimensions of quality maternal healthcare positively influence client satisfaction. The outcomes also indicate that 50% of the facilities were found to be inadequate with infrastructure such as placental pits, equipments, incinerators and 83.3% of the facilities not utilizing the partograph in monitoring mothers in labor. It is recommended that the county government strengthen the infrastructural aspects in the facilities and mechanisms for monitoring quality of healthcare delivery. Employment and equitable distribution of staff across the facilities. The County government to embrace stakeholder involvement in provision of quality maternal healthcare as this enhances equitability, efficiency, and effectiveness service delivery. Mechanisms for dissemination, implementation and monitoring of the policies/guidelines should be put in place.