What does quality of care mean for maternal health providers from two vulnerable states of India? Case study of Bihar and Jharkhand

Abstract

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.

Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities

“…23 Some of the contextual barriers-such as lack of respect and teamwork between obstetricians and midwives, heavy workloads, and challenges in maintaining continuity of labor monitoring and care by midwives-have been reported by health professionals in both high-and low/middleresource settings. [27][28][29][30] Although some of the health systems challenges may not be amenable in the short term, these findings provide a clear understanding of the potential obstacles that any labor monitoring tool must overcome to function in a real-life setting.…”

Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

“…Few opportunities have been identi ed in quality of MCH care service delivery in India. One study detected that there are quality enablers in health care institutions 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 22 . Another study has spotted that improved skills and con dence among providers, inclusion of doctors in training, increased training frequency, administrative support, and nursing supervision and feedback as factors for facilitating obstetric and neonatal emergency care 26 .…”

“…When considering the quality of MCH care, facility readiness was detected as poor for emergency obstetric care and newborn care in public and private health facilities including primary care facilities both rural and urban areas in India, Nepal and Bangladesh 21,31,47,56 . Several studies detected inadequate infrastructure leads to poor quality in maternal and child care including family planning services in the region 12,[22][23][24]26,28,38,45,51,52,56,60,65,73 . In addition to those problems, irregular supply of water and electricity, lessfunctioning of blood bank 12 , inadequate laboratory facilities 12,56,61 were detected as challenges.…”

“…Inadequate healthcare workers including specialists was identi ed as a challenge for provision of better maternal and neonatal care in India, Nepal, Bangladesh, Indonesia, Timor-Leste and Myanmar 12,22,24,26,29,8,45,47,49,51,56,61,63,69,73 . Shortage of staff is widespread in rural areas.…”

“…Suboptimal knowledge and skills among workers in the eld leads to poor quality MCH 22,35,47,65,68 . Few social, professional and economic barriers are identi ed with midwifery personnel in Bangladesh which preventing quality maternity care 53 .…”