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Differences in the Quality of Reproductive Health Services Provided by Private Midwives in Uganda

Differentials in quality of health services in the private sector by clients' socioeconomic status have not been well documented. This paper examines differentials in quality of reproductive health services provided by private midwives in Uganda. Data were collected from interviews of 248 midwives and observations of the same midwives' clients before and after a quality improvement intervention implemented by the Private Sector Partnerships-One (PSP-One) project. Improvements in quality were observed at follow-up. The data revealed some evidence of differentials in certain aspects of quality depending on clients' educational attainment and employment status. The differences likely resulted from clients' different demands for services and providers' response to the demands rather than from differential provider treatment of clients. Results suggest that improved overall quality does not necessarily result in lower differentials in quality of care. Strategies to reduce quality differentials may include client education about appropriate health services and enabling disadvantaged clients to demand high-quality services while providers maintain a set of minimal quality standards for all clients.