Quality of antenatal care services in public health institutions of Lumbini Province, Nepal: a SERVQUAL based gap analysis

High-quality care during pregnancy, childbirth, and the postnatal period is vital for ensuring safe motherhood and reducing maternal and newborn deaths. Patient satisfaction is a crucial component of healthcare quality and an essential priority for the health system. Improving maternal health outcomes depends not only on increasing service use but also on maintaining high standards of care. This study aimed to assess the quality gap in antenatal care services provided by public health institutions in Lumbini Province, Nepal. A cross-sectional analytical study was conducted in 30 health institutions, involving 2986 pregnant women who availed antenatal care (ANC) services across various public health institutions in Lumbini Province during July to December 2023. The quality gap of these institutions was assessed using the validated SERVQUAL tool, focusing on dimensions such as tangibility, reliability, responsiveness, assurance, and empathy. A paired t-test was applied to compare perception and expectation scores, with a significance level of p < 0.05. Among the participants, 76.7% were aged 20–29 years, with the mean age of 25 ± 4 years, 38.5% belonged to the Janajati ethnic group, 32.5% had completed secondary-level education, and 78.8% were housewives. The overall service quality gap was negative across all dimensions. The highest gap was observed in tangibility (− 0.89, 95% CI: −0.91 to − 0.85), and the lowest in empathy (− 0.49, 95% CI: −0.52 to − 0.45). The overall mean gap was − 0.639 (95% CI: −0.67 to − 0.60), and the difference between perception and expectation was statistically significant (paired t-test, p < 0.001). This study revealed gaps across all dimensions of ANC service quality in public health facilities in Lumbini Province; with the highest gap observed in the tangible dimension. The findings provide important evidence to guide policy and programmatic efforts aimed at strengthening the quality of antenatal care services in the province through systematic improvement across all dimensions.