Quality of health care and its effects in the utilisation of maternal and child health services in Kenya.

OBJECTIVE: To assess the quality of care provided by the Kisumu Municipal health facilities, with special reference to Maternal and Child health services (MCH).
DESIGN: A descriptive cross-sectional survey.
SETTING: Kisumu Municipal Health facilities.
SUBJECTS: Four hundred and eighty two mothers were interviewed in a household survey.
RESULTS: A total of 482 mothers were interviewed in the household survey. Out of these, only 40.4%, 53.7% and 45.7% had respectively used Municipal facilities for antenatal services (ANC), immunisation and treatment of their children the last time they required such a service. This translates to by-pass rates for Municipal health facilities of 59.5%, 46.3% and 54.3% respectively for the three services. By-pass was higher for the more central urban catchment areas than the more peripheral ones, a finding that was associated with the socio-economic status of the respondents and the relative location of the municipal facilities vis-a-vis competing facilities, mainly the District and Provincial hospitals. The main reasons cited for by-pass were poor care (21%), lack of drugs and supplies (17%) and lack of/poor laboratory services (12%). From the facility audit, most of the clinics had a reasonable capacity to offer basic health care with only three scoring less than 50% in the scale used. The worst areas were in availability of drugs, equipment and management issues. There was a strong relationship between the perceived quality of care and utilisation of MCH services as well as by-pass. The capacity of the facilities to offer care was however not associated with utilisation of MCH services or by-pass.
CONCLUSION: There is under-utilisation of Municipal health facilities for MCH services. This is related to the perceived poor quality of care in the facilities. Perception of quality is influenced by a person's socio-economic status especially education.