BackgroundQuality instillation has its own challenges, facilitators and barriers in various settings. This paper focuses on exploration of quality components related to practices, health system challenges and quality enablers from providers’ perspectives with a focus on maternal health studied through a pilot research conducted in 2012–2013 in two states of India—Bihar and Jharkhand—with relatively poor indicators for maternal health.MethodsQualitative data through in-depth interviews of 49 health providers purposively selected from various cadres of public health system in two districts each from Bihar and Jharkhand states was thematically analysed using MAXQDA Version 10.ResultsMaternity management guidelines developed by the National Health Mission, India, were considered as a tool to learn instillation of quality in provision of health services in various selected health facilities. Infrastructure, human resources, equipments and materials, drugs, training capacity and health information systems were described as health system challenges by medical and paramedical health providers. On a positive note, the study findings simultaneously identified quality enablers such as appreciation of public-private partnerships, availability of clinical guidelines in the form of wall posters in health facilities, efforts to translate knowledge and evidence through practice and enthusiasm towards value of guidelines.ConclusionsAgainst the backdrop of quality initiatives in the country to foster United Health Care (UHC), frontline health providers’ perspectives about quality and safety need to be considered and utilized. The provision of adequate health infrastructure, strong health management information system, introduction of evidence-based education and training with supportive supervision must constitute parallel efforts.

Despite being clinically sound, Indian guidelines score poorly due to weak documentation about their development process. It is recommended that the guideline development process be improved with systematic documentation for achieving standardization.

Introduction: The anemia management program for adolescent girls (15-19 years) was part of Eastern Uttar Pradesh Health Initiative implemented by Tata Trusts in 9 districts and 19 blocks in partnership with block level community-based organizations. Objective of the Health Initiative was to build community-based platform (In the form of Village Health and Nutrition Day -VHND) to provide primary healthcare services for basic maternal, child and adolescent health. The anemia management component in the program was based on the National Iron Plus Initiative guideline.Objectives: To ascertain prevalence of anemia in adolescent girls registered in the program; to demonstrate a community-based model for anemia management with the help of adolescent collectivization facilitated by trained front line health workers.Materials and Methods: Total 26,982 girls were screened in first phase of the program from April 2014; followed by second and third screenings with average duration of 3-6 months between each screening. Total 18,428 girls participated in second screening and total 13,979 girls were part of all three screenings till September 2015. WHO recommended Hemoglobin (Hb) Color Scale Method was used as a screening tool, implemented by auxiliary nurse midwives and lab technicians. Girls' collectivization was facilitated by the trained frontline health workers to spread awareness, mobilize girls for screening and conduct health education sessions. Data is from the project MIS and was analyzed with the help of Microsoft Excel and SPSS.Results: Project implementation level data across 19 sites for 3 checkups with mean interval between each checkup as 3-6 months, shows prevalence of anemia in adolescent girls was 86.80%. Mean rise of hemoglobin from checkup 1 to checkup 3 is 0.6 gm. Drastic reduction in severe anemia from 5.66% to less than 1% is seen in the program. In case of non-school-going girls, reduction in severe anemia was from 17% to 1.5%. Conclusion:Overall burden of anemia in adolescent girls (15-19 years) is very high in girls in late adolescence stage. As age increases, prevalence increases, non-school-going girls are worst affected with severe anemia. It is promising to implement anemia management program through a platform led by a trained frontline health worker facilitated adolescent girls' collectivization. Community-based strategies and individual follow up is significant to reduce burden of severe anemia.