Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh

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