ALIGNING EXPECTATIONS: A COMPARATIVE ANALYSIS OF PROVIDER AND CLIENT PERSPECTIVES ON RESPONSIBLE MATERNAL HEALTH SERVICES IN OKADA, EDO STATE

Abstract

Responsible maternal health services (RMHS) depend on alignment between what providers deliver and what clients expect and experience, yet maternal health studies rarely assess both groups together in the same setting. This study compared provider and client perspectives on RMHS in Okada, Edo State, Nigeria. A descriptive cross-sectional study utilizing a mixed-methods (quantitative and qualitative) approach was conducted among 249 females of reproductive age (15–49 years), recruited by two-stage cluster sampling, and 43 health workers, recruited by census. Quantitative data were collected using structured questionnaires assessing knowledge and perception of RMHS; qualitative data were obtained through one focus group discussion, one in-depth interview, and one key informant interview. Good knowledge of RMHS was demonstrated by 217 (87.1%) of clients and 40 (93.0%) of providers, while positive perception was recorded among 223 (89.6%) of clients and 42 (97.7%) of providers. Despite these broadly favorable overall scores, alignment broke down on specific items: only 13 (30.2%) of providers agreed their facility had adequate staff and resources, while 68 (27.3%) of clients cited health worker attitude and 58 (23.3%) cited service quality as barriers to utilization. Providers markedly underestimated client awareness of facility-based delivery (provider mean = 2.44/5.0) relative to clients’ self-reported 76.3% awareness of RMHS. Qualitative accounts corroborated these gaps: clients described long waiting times and discomfort with student involvement at the teaching hospital, while the key informant confirmed staffing shortages and drug stock-outs. Providers and clients converge on the value of RMHS and hold broadly positive attitudes toward it but diverge sharply on facility readiness, respectful care, and client awareness, representing a modifiable expectation gap. Facility-level quality improvement initiatives that explicitly reconcile provider and client perspectives are recommended for Okada and comparable semi-urban Nigerian communities.