Magazine article Journal of Services Research

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

Magazine article Journal of Services Research

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

Article excerpt


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. The focus of the large projects at state or national level has mainly been on infrastructure and manpower development, with less concerted attempts to improve the service utilization and service quality (UNFPA, 1992).


The objectives of the paper are to assess the quality of care of reproductive health services and to determine factors responsible for the current level of quality of services in the context of primary health care in Udaipur district of a major Indian state, Rajasthan.


The study was conducted in Udaipur district of Rajasthan. District as a unit was identified for the study. The Udaipur district was selected because; a) it is one of the 90 poor performing districts in India, identified by the Department of Family Welfare, Ministry of Health and Family Welfare, Government of India. The poor performing districts are characterized by high birth rates, high infant mortality rates and very low levels of institutional deliveries.; b) it is one of the tribal districts of Rajasthan with about 40 per cent tribal and disadvantaged population; and c) The researcher is well acquainted with the district and has had experience of working with the Health Department in various projects in the district. Hence, it was assumed that the district management would render better cooperation in collecting data and information.

Assessing Quality of Care: To assess the quality of care in Udaipur district, the Bruce Quality of Care framework has been used (Bruce 1990). Bruce has proposed that several program features can be thought of as the operational components of quality of care in family planning programs. These program features are the six elements that together constitute quality of care: (1) choice of methods; (2) information given to clients; (3) technical competence; (4) interpersonal relations; (5) Follow-up or continuity mechanisms; and (6) appropriate constellation of services. …

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