Using mixed methods to evaluate perceived quality of care in southern Tanzania

OBJECTIVE: To compare perceived quality of maternal and newborn care using quantitative and qualitative methods. DESIGN: A continuous household survey (April 2011 to November 2013) and in-depth interviews and birth narratives. SETTING: Tandahimba district, Tanzania. PARTICIPANTS: Women aged 13–49 years who had a birth in the previous 2 years were interviewed in a household survey. Recently delivered mothers and their partners participated in in-depth interviews and birth narratives. INTERVENTION: None. MAIN OUTCOME MEASURES: Perceived quality of care. RESULTS: Quantitative: 1138 women were surveyed and 93% were confident in staff availability and 61% felt that required drugs and equipment would be available. Drinking water was easily accessed by only 60% of respondents using hospitals. Measures of interaction with staff were very positive, but only 51% reported being given time to ask questions. Unexpected out-of-pocket payments were higher in hospitals (49%) and health centres (53%) than in dispensaries (31%). Qualitative data echoed the lack of confidence in facility readiness, out-of-pocket payments and difficulty accessing water, but was divergent in responses about interactions with health staff. More than half described staff interactions that were disrespectful, not polite, or not helpful. CONCLUSION: Both methods produced broadly aligned results on perceived readiness, but divergent results on perceptions about client–staff interactions. Benefits and limitations to both quantitative and qualitative approaches were observed. Using mixed methodologies may prove particularly valuable in capturing the user experience of maternal and newborn health services, where they appear to be little used together.