“If I am alive, I am happy”: Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea

Background Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. Methods An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using reflexive thematic analysis, assisted by NVivo computer software. Results Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Conclusion Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. Participants believe that the current standard of care does not align with how they define quality of care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding was provided by the Burnet Institute through philanthropic support from numerous private and business donors in Australia and PNG. Major funding was provided by June Canavan Foundation Australia Gras Foundation, Australia Bank South Pacific PNG Community Grant Steamships PNG Community Grant Alistair Lucas Prize for Medical Research National Health and Medical Research Council (NHMRC) of Australia (Fellowships to CSE and JGB, Postgraduate Research Scholarship to AW) Naylor Steward Ancillary Fund, and the Chrysalis Foundation. MJLS received a Basser Research Entry Scholarship from the Royal Australasian College of Physicians Foundation (2018 and 2020). Burnet Institute is supported by an Operational Infrastructure Grant from the State Government of Victoria, Australia, and the NHMRC Independent Research Institutes Infrastructure Support Scheme. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study received ethical approval in PNG from the PNG Institute of Medical Research Institutional Review Board (1903) and the National Department of Health Medical Research Advisory Committee (19.16), and in Australia from the Alfred Hospital Human Research Ethics Committee (267/19). All participants involved in the study provided written and verbal informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets generated and/or analysed during the current study are not publicly available due to potential confidentiality concerns. Additional information can be made available from the Scientific Integrity Officer at Burnet Institute, (admin{at}burnet.edu.au), on reasonable request. These restrictions are per the Papua New Guinea, Institute of Medical Research, Institutional Review Board.