Provider and district continuity and fragmentation of care during pregnancy and delivery in the Volta Region, Ghana

Abstract

Background: Continuity of care (CoC) measures the extent to which a patient is attended to by a given provider over a specified period. It
can be measured at the level of a patient to a provider or at the level of a provider to determine the average proportion of care provided by the provider.
Objective: The study aimed to determine the extent of provider and district continuity of care and the level of care fragmentation among
districts during antenatal and delivery.
Methods: National Health Insurance claims data for 2013 in the Volta Region was used for the study, with 14,474 pregnant women meeting the inclusion criteria of delivery at a health facility and making at least two antenatal care visits. Provider continuity of care was  calculated, and a social networking analysis approach was used to determine the level of care fragmentation across districts based on  patient-sharing among districts. Network graphs were constructed to help visualise the fragmentation of care among districts during  antenatal care and delivery.
Results: There were 196 providers from 26 districts involved in the study; 15% (n = 2,185) of the pregnant women had caesarean section
(CS) delivery. The average provider and district continuity of care scores were 67% and 81%, respectively. About 12.70% (n = 1838) of all
deliveries and 19.95% (n = 436) of all caesarean section deliveries were fragmented across districts. Among those with multiple providers,
about 30.51% (n = 1,838) of all deliveries and 45.41% (n = 436) of CS were fragmented across districts. Eight districts that do not have
hospitals located in them had more fragmentation during delivery (25% - 81%) compared to districts with hospitals.
Conclusion: Fragmentation of care during antenatal care and delivery was higher in districts without hospitals compared to districts with
hospitals.