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