Women's perception of antenatal care services in public and private clinics in the Gambia

Objective: The main objective of this study was to assess women's preferences and perception of antenatal healthcare services in public and private healthcare facilities. Design: Descriptive cross-sectional study using a face-to-face interview based on the standardized World Health Organization questionnaire. Setting: Six public and six private health facilities in the Gambia. Participants: Five hundred and two pregnant women. Intervention: Not applicable. Main Outcome Measures: Patient's perception of antenatal services received was main outcome variables and measured in three aspects: willingness to come back, willingness to recommend to others and level of satisfaction. Results: The satisfaction rate with antenatal services was 79.9% for public facilities and 97.9% for private facilities. Pregnant women's poor perception with public facilities (after adjustment) included their unhappiness, with the following dimensions of antenatal care (ANC): inadequate privacy, inadequate space and neatness and inadequate communication with care providers. Conclusion: We found that although women tended to be highly satisfied with both private and public ANC facilities, those attending public clinics were significantly less satisfied than those attending private clinics. The main complaints were related to the physical environment, technical process and provision of information or reassurance. Because public facilities constitute the main care providers for the general population and particularly for disadvantaged women, better management of public clinics and better training in communication skills for public care providers may help to retain women patients and improve the quality of ANC in the public sector.