Bound to be Satisfied: User and Provider Perspective on Facility-based Obstetric Care in Rural Bangladesh

Client satisfaction, the degree of fulfillment of patient’s desired expectations and preferences for healthcare, is one of the outcome variables for assessment of the quality of health services. Until now, the experience and perception of satisfaction of clients and providers with obstetric care facilities in rural areas of Bangladesh is unknown. This study aimed to determine the perceived level of satisfaction of rural clients in the northern region of Bangladesh who received facility-based care for their obstetric needs and to identify factors behind their perception. A qualitative study was carried out in two upazilas, Nandail from Mymensingh and Kendua from Netrokona, among the women who received facility-based obstetric services, husbands or other female attendants of those women, and providers of the UHCs in two study upazilas. A total 48 in-depth interviews and 2 informal discussions were conducted. Data were analysed by employing the concept of Graneheim and Lundman model for content analysis. Most of the respondents, both clients and providers, from the study UHCs expressed satisfaction; yet, the majority of them labelled their satisfaction as “bound-to-besatisfied,” as they marked some areas of dissatisfaction and felt powerless or unable to change the situation. The referred clients who received care at the public facility were mostly dissatisfied while the clients who sought care at the private clinic were satisfied.
According to the analysis, factors associated with satisfaction are: perceptions about interpersonal communication (behavior, responsiveness, communication during clinical service), medical services (examination and obstetric services), cost (worthiness of payment and informal payment), environment (cleanliness, noise, smell), resources (human resource, infrastructure, logistics for medical services, food and toilet), and the transfer from home to facility (transport, condition of the road, time to reach facility). Both clients and providers recognised the limitations of facility-based services in the rural area and effectively managed some of those by local efforts. Evidence on gaps in the aspects of quality of obstetric care generated from this study is useful for policymakers for prioritising the distribution of health workforce and the allocation of resources. On the other hand, there lies an opportunity for BRAC’s IMNCS programme being implemented in one of the study areas to develop a well-designed information package about facility-based services, which may be used to raise awareness among rural clients about their rights to healthcare.


Ishaque, T. and Begum, K. (2014), Bound to be Satisfied: User and Provider Perspective on Facility-based Obstetric Care in Rural Bangladesh, Working Paper: BRAC Research and Evaluation Division, Published September 2014

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