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Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
Örebro University, School of Health Sciences.
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. , 123 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 64
Keyword [en]
Bangladesh, hospital, maternal health, newborn health, quality improvement
National Category
Other Health Sciences
Identifiers
URN: urn:nbn:se:oru:diva-48416ISBN: 978-91-7529-123-9 (print)OAI: oai:DiVA.org:oru-48416DiVA: diva2:904644
Public defence
2016-03-18, Långhuset, L153, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2016-02-19 Created: 2016-02-19 Last updated: 2016-02-22Bibliographically approved
List of papers
1. Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study
Open this publication in new window or tab >>Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study
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2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, 237Article in journal (Refereed) Published
Abstract [en]

Background: Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals.

Methodology: Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines.

Results: The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments.

Conclusion: The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2015
Keyword
Bangladesh, clients' satisfaction, healthcare providers' perception, maternal and neonatal health, quality of healthcare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Medical Care Research
Identifiers
urn:nbn:se:oru:diva-45294 (URN)10.1186/s12913-015-0918-9 (DOI)000356584000001 ()26084893 (PubMedID)2-s2.0-84935856544 (Scopus ID)
Available from: 2015-07-23 Created: 2015-07-20 Last updated: 2016-02-22Bibliographically approved
2. Assessment of quality of infrastructure and clinical care performance of HCPs during MNH services at district and sub-district level government hospitals, Bangladesh
Open this publication in new window or tab >>Assessment of quality of infrastructure and clinical care performance of HCPs during MNH services at district and sub-district level government hospitals, Bangladesh
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2015 (English)In: HealthMed, ISSN 1840-2291, E-ISSN 1986-8103, Vol. 9, no 12, 500-510 p.Article 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
Keyword
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:nbn:se:oru:diva-47959 (URN)
Available from: 2016-02-04 Created: 2016-02-04 Last updated: 2016-02-22Bibliographically approved
3. A Model Quality Improvement System for Maternal and Newborn Health Services Applicable for District and Sub-district Level government hospitals in Bangladesh: Description of Model Development process
Open this publication in new window or tab >>A Model Quality Improvement System for Maternal and Newborn Health Services Applicable for District and Sub-district Level government hospitals in Bangladesh: Description of Model Development process
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(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-48459 (URN)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2016-03-02Bibliographically approved
4. Evaluation of a “Model Quality Improvement System" for MNH service for its acceptability and feasibility by the health care providers and patients in district and sub-district level government hospitals, Bangladesh
Open this publication in new window or tab >>Evaluation of a “Model Quality Improvement System" for MNH service for its acceptability and feasibility by the health care providers and patients in district and sub-district level government hospitals, Bangladesh
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(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-48460 (URN)
Available from: 2016-02-22 Created: 2016-02-22 Last updated: 2016-02-22Bibliographically approved

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