A framework for assessing quality of maternal health services and preliminary findings from its application in Urban India

This paper introduces a framework for assessing the quality of care of institutional maternity services developed by researchers at the University of Southampton. The framework divides quality into two parts: the quality of the provision of care and the quality of users’ experience of care. Preliminary findings from the application of this framework within a slum area of Mumbai are presented. Data from municipal and private hospitals were collected using a community survey of 650 women, observation, exit interviews, provider interviews, review of hospital records, and the mystery client approach. Findings provide evidence that quality is far from optimal in both municipal and private facilities. Quality issues identified include a lack of essential drugs, the use of inappropriate procedures that are not evidence-based, users being left unsupported, evidence of physical and verbal abuse and institutional delivery which does not guarantee attendance by a health professional. There is also evidence that the quality of experience of care varies significantly by background characteristics of the woman and her family