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Assessment of quality of infrastructure and clinical care performance of HCPs during MNH services at district and sub-district level government hospitals, Bangladesh
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0003-0185-0851
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2015 (English)In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 12, p. 500-510Article in journal (Refereed) Published
Abstract [en]

Background: Despite the progress towards the MDG4 and 5, compared to the developed world maternal and newborn deaths are still high in Bangladesh. Poor quality of maternal and newborn health care is often blamed for this high mortality. However, only few studies assessed the quality of health care of the facilities in Bangladesh. This study assessed the two important components of quality of maternal and newborn health care namely, infrastructure and performance of health care providers (HCPs) of three different levels of health facilities in Bangladesh.

Methodology: A cross sectional survey including observation and document reviews conducted to measure the quality of infrastructures and to assess the clinical care performance of the health care providers related to maternal and newborn services. Two district hospitals, two maternal and child welfare centres, and 10 upazila (sub-district) health complexes were purposively selected from Thakurgaon and Jamalpur districts of Bangladesh to conduct the study. Six components including human resource, physical infrastructure, infection prevention, equipments/logistics/supplies, essential drugs and recordkeeping were assessed under infrastructure. Maternal and newborn care services provided by the health care providers were evaluated during antenatal care, postnatal care, conduction of delivery care and newborn care. Sixteen doctors using pre-tested infrastructure survey and observation checklists collected data between November and December 2011. The average of the sub-items of each item was calculated and then the mean average of the items were calculated and expressed in percentage. Ethical clearance was obtained from a competent authority and informed consent was obtained from the hospital authorities and the persons who participated in the study.

Results: The percentage of mean average scores of all items of infrastructure for district hospitals, maternal and child welfare centres and upazila health complexes were 57.1%, 52.7% and 45.9% respectively, which were below the cut-off point (60.0%). None of the health care providers of three types of government hospitals obtained 100% score in any areas namely antenatal care, post-natal care, delivery care and newborn care.

Conclusion: Quality of infrastructure of health facilities, and clinical care performance of the health care providers during discharging maternal and newborn health services were found poor in the selected three types of public hospitals.

Place, publisher, year, edition, pages
Sarajevo, Bosnia & Herzegovina: D R U N P P , 2015. Vol. 9, no 12, p. 500-510
Keywords [en]
Health care providers, public hospital, infrastructure, maternal and newborn health, performance, quality improvement
National Category
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:oru:diva-47959OAI: oai:DiVA.org:oru-47959DiVA, id: diva2:900680
Available from: 2016-02-04 Created: 2016-02-04 Last updated: 2018-07-02Bibliographically approved
In thesis
1. Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
Open this publication in new window or tab >>Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In Bangladesh, research focusing on the quality of maternal and newborn health (MNH) services in hospitals remains neglected. There have only been a few studies conducted on quality issues and found the quality of MNH care provided at district and sub-district hospitals to be poor. The overall objective of this thesis was to develop, implement and evaluate a framework for quality improvement (QI) system for MNH care at the district and sub-district level government hospitals in Bangladesh. The thesis is comprised of four papers. Mixed methods were used in paper I and paper IV. In paper II quantitative methods were utilized, and to develop the “Model QI System”, exploratory methodological approaches were used and illustrated in paper III. Group discussions, focus group discussions, in-depth interviews, documents review and photography were utilised as qualitative data collection techniques. Through structured observation and exit interviews quantitative data were obtained. Findings of baseline survey identified several keyfactors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under useof patient-management protocols; lack of training; and insufficient supervision. The clinical performance of health care providers was found unsatisfactory. Utilizing the baseline survey findings and existing information on QI models, theories and QI intervention programmes implemented in defferent settings an adapted “Model QI System” and its implementation framework, guidelines and tools were developed. The key areas of this “Model QI System” included health system support, clinical service delivery, inter-departmental coordination; and utilization of services and client satisfaction. The adopted “Model QI System” was incorporated within the existing hospital management system and it was found that the quality of care improved. The evaluation of the study showed that the “Model QI System” was acceptable to the top health managers, health care providers and hospital support staff and feasible to implement in district and sub-district hospitals in Bangladesh.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 123
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 64
Keywords
Bangladesh, hospital, maternal health, newborn health, quality improvement
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-48416 (URN)978-91-7529-123-9 (ISBN)
Public defence
2016-03-18, Långhuset, L153, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15 (English)
Opponent
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Available from: 2016-02-19 Created: 2016-02-19 Last updated: 2017-10-17Bibliographically approved

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Islam, FarzanaEriksson, CharliDalal, Koustuv

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