Diagnosing Quality of Reproductive Health Services Provided through Public Health System in India: Application of System's Framework

Article excerpt

Quality of care has emerged as a central issue in reproductive health. The need for improving quality is intensely realized, as the health services remain grossly under-utilized despite an extensive network of infrastructure and manpower. The study has been carried out to assess the quality of care of reproductive health services and to determine factors responsible for the current level of quality of reproductive health services in the context of public health system in Udaipur district of a major Indian State Rajasthan. The study is based on both primary and secondary data. It has used both quantitative and qualitative information. Bruce Quality of Care framework has been used to assess the quality of care, which incorporate six elements: choice of methods, information given to users, technical competence, interpersonal relations, follow-up/continuity mechanisms, and appropriate constellation of services. These elements reflect six aspects of the services, identifying client experience as critical. The quantitative score for each indicator has been calculated. The overall score for the quality of care for the district worked out to be 37 on a scale of 0 to 100. This shows that the current situation of quality of care in the district is poor. To determine the factors affecting the current performance of quality of care, a systems approach, using Jain's Diagnostic Model (consisting of five components, viz., Desired Output, Environment, Input, Information, and Process) has been used. After detailed diagnosis of these components, a few vital factors have been identified as highly important, with low favourablity and highly manipulable for improving systems performance.

INTRODUCTION

Quality improvement in providing of reproductive health (RM) services is expected to have an important impact on efficiency, client satisfaction and utilisation (Geyndt, Willy De 1995; Satia, Jay, 1993; and Pathfinder International, 1993). Quality of care is often considered unaffordable for programs with limited financial resources. However, ensuring quality of care is more likely to result in a more efficient use of resources, because the interventions will have greater health benefits. It will result in a larger, more committed clientele of satisfied clients.

Recent attention to the quality of RH services has highlighted the fact that historically, these services have usually been evaluated more in terms of the degree to which they have achieved demographic objectives, such as fertility decline or the reduction of infant and maternal mortality, than in terms of the quality of the services deployed to achieve those outcomes. The quality of routine operations of RH services that daily serve millions of people worldwide and may have significant impacts on both safe and informed contraceptive choices and safe motherhood practices has become the focus of donor and government attention only in the last few years.

India has made considerable progress in the last few decades in expanding the public health system and reducing the burden of disease. The National Health Policy (NHP) of 1983 has set targets for improving the health status of the population and reducing fertility. An extensive infrastructure has been developed during the last decade for public provision of primary health care services. Partly as a result of these efforts, the infant mortality rate (IMR) at the all India level had been reduced to 74 per 1,000 live births by 1994. The situation is more alarming in the case of Rajasthan. The present health care system in Rajasthan is faced with serious problems with respect to efficiency, effectiveness and quality. These problems prevent the health system from achieving the desired outcomes.

Quality of care has emerged as a central issue in reproductive health. The need for improving quality is intensely realized, as the health services remain grossly under-utilized despite an extensive network of infrastructure and manpower. …