A Comparative Appraisal of Socio-Economic Profiles and Perceptions of Women on Health System Responsiveness of Government and Semi-Government Maternity Services at Childbirth: Evidence from Sri Lanka

Background. Health system responsiveness is a multidimensional construct that encompasses the non-clinical aspects pertaining to ways and environments in which individuals are being treated. Medicalization of child birth ensures safe delivery but poses challenges for women, and their socio-demographic characteristics may influence accessing government or private sector maternal services. Nevertheless, their perceptions on responsiveness of those services would reflect a crucial aspect of quality of care provided. Objective. This study is aimed at comparing socio-economic profiles and perceptions of women on responsiveness of maternal services they received at child birth provided by government and semi-government sectors in Sri Lanka. Method. A hospital based descriptive cross-sectional study was conducted with comparative components among maternity patients in a government district general hospital and a tertiary care semi-government hospital in Sri Lanka. The total sample comprised of 383 women who delivered their babies at respective institutions (n=193) in government sector and (n=190) in semi-government sector. Data were collected using an interviewer administered questionnaire supported by non-participatory observations. Results. Women who accessed services from two sectors displayed significant differences in their socio-demographic profiles. The level of overall perceived health system responsiveness at child birth deemed significantly lower for the government sector compared to the semi-government sector (p<0.05). Majority of the government hospital users rated “basic amenities” (77.7%) as the most important element in health system responsiveness whilst 97.3% of women who accessed semi-government sector rated “communication” as the crucial element. Conclusion. Women who accessed government and semi-government sectors for childbirth demonstrated heterogeneous socio-demographic profiles. The perceived health system responsiveness of the semi-government hospital was significantly higher than the government hospital. Reducing the over crowdedness in tertiary health care institutions by improving facilities at lower level maternity services could be able to enhance health system responsiveness in Sri Lankan context. Key words: Maternal health services, health system responsiveness, parturition, public, private sector, Sri Lanka