A method for assessment of quality of child health care in under fives' clinic of primary health centres

1980 ◽  
Vol 47 (4) ◽  
pp. 283-287
Author(s):  
D. K. Srinivasa ◽  
M. Danabalan
2013 ◽  
Vol 6 ◽  
pp. HSI.S11226
Author(s):  
Enakshi Ganguly ◽  
Bishan S. Garg

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.


2004 ◽  
Vol 29 (3) ◽  
pp. 71-82 ◽  
Author(s):  
P Rameshan ◽  
Shailendra Singh

This paper provides an evaluation of the quality of services and customer orientation of Primary Health Centres (PHCs) against the backdrop of the changed environment in the country with customer focus and efficiency emerging as the cornerstones of economic transactions in private and public sectors alike. It focuses on ten selected PHCs of Uttar Pradesh and covers the following stakeholders: Customers including patients who use the health care facilities of PHCs as well as the relatives and their personal attendants. Community members covering the village public, local shopkeepers, local government functionaries, local intelligentsia such as teachers and others having an interest or stake in PHC activities. Doctors and staff of the PHCs. District Medical Officials responsible for controlling and monitoring the PHC activities. The paper draws, among others, the following conclusions: The customers and community members of the villages perceived the facilities and services of PHCs to be deficient in many respects. Neither doctors and PHC staff nor the district officials are able to refute adequately the issues raised by villagers about the quality of service of PHCs. While villagers do not like the panchayat (local government) coming into the picture for improving the services of PHCs, district officials totally discount privatization as a means for providing effective primary health care in rural areas. While it is not very easy to solve the primary health care problems of the Indian villagers, yet the policy-makers can take recourse to the following measures to improve the facilities and services of PHCs in future: Form village committees to monitor PHC facilities, resources, and services. Identify industry patrons/sponsors for each PHC for developing infrastructure, facilities, and logistics without straining the scarce government resources. Constitute district-level user committees to monitor not only the PHC activities of a district but also the activities of the District Medical Offices. Enable panchayat and district administration to perform monitoring and supporting functions to ensure multiple checks on activities of the PHCs and District Medical Offices.


2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.


1996 ◽  
Vol 20 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Mohan Isaac

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.


2005 ◽  
Vol 61 (3) ◽  
pp. 613-625 ◽  
Author(s):  
Eleanor Gouws ◽  
Jennifer Bryce ◽  
George Pariyo ◽  
Joanna Armstrong Schellenberg ◽  
João Amaral ◽  
...  

2013 ◽  
Vol 23 (2) ◽  
pp. 151
Author(s):  
Maria Lucélia Da Hora Sales ◽  
Liz Ponnet ◽  
Carlos Eduardo Aguilera Campos ◽  
Marcelo Marcos Piva Demarzo ◽  
Cláudio Torres de Miranda

ResumoObjetivo: verificar a qualidade da atenção à saúde da criança pelas equipes da Estratégia Saúde da Família (ESF) em Capital do Nordeste do Brasil. Método: trata-se de um estudo transversal, descritivo, com abordagem quantitativa, realizado durante o ano de 2010, por meio de inquérito com os profissionais médicos e enfermeiros de 66 equipes da ESF de Maceió-AL, estratificadas por tempo de funcionamento em anos. Utilizou-se parte do instrumento de auto-avaliação denominado Avaliação para Melhoria da Qualidade da Estratégia Saúde da Família (AMQ) do Ministério da Saúde, especificamente as questões referentes às ações e atividades realizadas no campo de atenção à “saúde da criança”, dentro da dimensão “atenção à saúde”. Resultados: os padrões elementares de qualidade foram encontrados em 84,1% das ações realizadas. Os padrões considerados avançados apresentaram o menor percentual de conformidade entre todas as equipes (47,7%). Quanto ao tempo de implantação da ESF, as equipes com menos de quatro anos tenderam a relatar melhores padrões de qualidade. Conclusões: os achados sugerem que as ações de saúde da criança estão sendo realizadas em melhor conformidade nas equipes com menos tempo de implantação, e que a grande maioria das equipes ainda estão atendendo a padrões considerados menos avançados em termos de qualidade.


BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e027147 ◽  
Author(s):  
Krishna D Rao ◽  
Swati Srivastava ◽  
Nicole Warren ◽  
Kaveri Mayra ◽  
Aboli Gore ◽  
...  

ObjectiveClinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses.DesignQuasi-experimental post-test with matched comparison group.SettingPrimary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities.ParticipantsAnalysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison).InterventionMentoring for a duration of 6–9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care.Primary outcome measuresNurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations.ResultsMentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed.DiscussionMentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.


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