Provider Attitude as a Modifier of Skilled Birth Attendance (SBA) Utilisation: Evidence from a Quasi-Experimental Study in Benue State, Nigeria
Keywords:
Facility Delivery, Leadership Training, Maternal Health Utilisation, Nigeria, Provider Attitude, Skilled Birth AttendanceAbstract
Across sub-Saharan Africa, high antenatal care (ANC) coverage frequently fails to translate into facility-based, skilled-attended deliveries. While economic and geographic barriers to skilled birth attendance (SBA) are well documented, provider interpersonal attitude is increasingly recognised as a modifiable, supply-side determinant of delivery-site choice. This study evaluated whether a Leadership Development Program (LDP) directed at frontline health workers improved provider attitude and, in turn, increased SBA utilisation and facility delivery volume in rural Benue State, Nigeria. A quasi-experimental study with a six-month post-intervention follow-up was conducted across 16 rural Primary Health Centres (PHCs) in Benue. Health workers at intervention PHCs received an LDP workshop. A cohort of 436 Women of Reproductive Age Group attending ANC was followed up. Data were analysed with IBM SPSS version 20 with significance set at p<0.05. Individual SBA attendance in the intervention group rose from 83.5% at baseline to 95.0% post-intervention (χ²=5.172, df=1, p=0.023). The proportion of total live births attended to by an SBA in the intervention group increased from 84.3% to 95.0% (χ²=4.666, df=1, p=0.031). Good provider attitude scores rose from 81.2% to 100.0% in intervention PHCs (χ²=45.256, df=1, p<0.001). Improving provider interpersonal attitude through structured leadership training significantly increased individual SBA utilisation among women already engaged in ANC. Provider attitude is therefore a powerful, rapidly modifiable determinant of care-seeking among existing clients; expanding population-level facility delivery coverage will additionally require structural health-system strengthening and community-based demand-generation strategies.
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