Labouring for quality: crossing the chasm in maternal health care in Trinidad and Tobago

Abstract

Trinidad and Tobago is a Caribbean country which is striving towards achieving developed country status in the global economic sphere. However, this is against a backdrop of a medical care system which is in a state of flux, and, in particular, has a high maternal mortality rate. The aim of this study was to investigate the quality deficit in maternal health care utilising an adapted version of a maternity quality model. This acted as a conceptual framework in order to explain the gaps in maternal health care and diagnose its weaknesses. This study adopted a mixed method approach using a combination of semi-structured interviews and a small-scale quantitative survey with key stakeholders within the public health system.

Two principal themes emerged: firstly, that the women who accessed maternity services were passive, with them mainly being receivers of the service provided and not using their agency to act within the system and exercise their right to choose. Secondly, health care professionals were passionate and devoted to their professions. However, they tended to be constrained by a health system that has been weakened by competing political, social, generational and cultural agendas, maldistribution, staff shortages, ageing workforce, facilities and equipment deficits.

The study concludes by suggesting that quality has been used as the vehicle to drive health sector reforms and has led to multi-sector alliances and partnerships. However, these alliances would be more effective with better cohesion of activities at all levels within the health system. Despite this, quality is perceived by the users as new and young and in a growth stage as it continues to grapple with the friction and fuzziness of logic of medical, managerial and administrative professionalism.

Key concepts explored: definitions of quality, health quality, Total Quality Management (TQM), Continuous Quality improvement (CQI), health quality models and frameworks, organisational behaviour, health reform, new public sector management, maternity care models, health and health care systems and health policy.