4 research outputs found
What does quality of care mean for maternal health providers from two vulnerable states of India? Case study of Bihar and Jharkhand
Background: Quality 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\u2019 perspectives with a focus on
maternal health studied through a pilot research conducted in
2012\u20132013 in two states of India\u2014Bihar and
Jharkhand\u2014with relatively poor indicators for maternal health.
Methods: Qualitative 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. Results: Maternity
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. Conclusions:
Against the backdrop of quality initiatives in the country to foster
United Health Care (UHC), frontline health providers\u2019
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
What does quality of care mean for maternal health providers from two vulnerable states of India? Case study of Bihar and Jharkhand
Appraisal of maternity management and family planning guidelines using the agree II instrument in India
Introduction: Guideline development gathered pace in India after the inception of National Rural Health Mission (NRHM) in 2005. However, there is a lack of adequate information about guideline development process, review, and update. This paper reports on the systematic appraisal of Indian guidelines related to maternity management (MM) and family planning (FP) using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, which was one of the components of a pilot research in 2012-13. Materials and Methods: Forty-four selected guidelines about MM and FP, identified through a consensus building workshop, were independently appraised by two appraisers with AGREE instrument having six different domains. Mean item scores, domain scores, and standardized scores were calculated by averaging the scores across the two appraisers. Results: Most guidelines scored high in scope and purpose and clarity of presentation. However, they had little documentation about the development group member details, incorporation of patient views, evidence search method, method chosen for formulating recommendations, tools for application, potential barriers, cost implications, and information about the funding body. Nonclinical guidelines scored higher than clinical guidelines (P = 0.01) for MM in the domain applicability. Clinical FP guidelines scored higher than nonclinical guidelines in the domain of rigor of development (0.01). Conclusion: 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