Over the years, as India' s health system developed, there has been an increased focus on quality in the health sector. This could be a reflection of the growing public awareness and concern about the kind of care provided at institutions, both public and private. In recent years, civil society has been raising its concern for quality in healthcare meant especially for the poor and the vulnerable sections of the population. In maternal health specifically, the potential gains of providing good quality care during pregnancy and delivery, in terms of lives saved for mothers and babies, are enormous. Across less developed countries, 95 per cent coverage of quality facility births could prevent an estimated half of all maternal deaths— around 150,000 women saved each year—and just over a third of all neo-natal deaths (Save the Children 2013). The concept of quality broadly encompasses clinical effectiveness, safety and a good experience for the patient and also implies care which is patient-centred, timely, efficient and equitable (Table 15.1) (Thompson et al. 1991, Institute of Medicine 1990). At the institutional level, Quality Assurance (QA) and Continuous Quality Improvement (CQI) are two interrelated mechanisms for ensuring quality in service provision. QA is a mechanism/process that contributes to ' defining, designing, assessing, monitoring, and improving the quality of healthcare (MoHFW 2008). It sets standards, assesses how standards are met and accordingly takes corrective action. In CQI, the approach is through plan-do-study-act method in which four repetitive steps are carried out over the course of small Dimensions Description STRUCTURE 1. Physical resources The resources required to enable the provision of quality care infrastructure, equipment, drugs and supplies. 2. Human resources Care provided by appropriately trained and supervised providers; numbers of staff adequate to meet the demand for care. PROCESS 3. Competent and Care consistent with scientific knowledge, efficient care internationally recognised good practice. Care is safe (avoidance of iatrogenic harm); timely and responsive (respectful, promoting autonomy, equitable). OUTCOME 4. Clinical Positive clinical outcomes achieved (e.g. Effectiveness mortality reduction). 5. Satisfaction Provider and patient-centric care. with care Sources: Adapted from Donabedian (1980), Hulton et al. (2000) and Institute of Medicine (1990).
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