Exploring the factors affecting quality of neonatal care services at a secondary level public hospital in Karachi, Pakistan : an exploratory mixed method study

Pakistan has not shown any improvement in neonatal mortality since past five years and currently it has the second highest neonatal mortality rates in the world. The trends are alarming and it is crucial that we take stock of this problem and to explore the factors behind failure to improve neonatal survival in Pakistan. Literature suggests that most of the neonatal deaths are preventable with low cost interventions at health facilities. The study aims to assess the factors affecting quality of neonatal services provided at a secondary care public sector facility in Karachi, Pakistan. Research Question: Which factors affect quality of neonatal services provided at a secondary level public sector hospital in Karachi, Pakistan? Methods: A mixed-method exploratory study design was used to assess the quality of neonatal services at secondary care public hospital in Karachi, Pakistan. World Health Organization\u27s conceptual framework of organizational management strategies for improvement in quality of care was applied to assess the multi-dimensional nature of quality of services. The study participants were mothers of newborns, healthcare providers and administrator of the facility. Quantitative data collection methods included facility observation and healthcare provider\u27s interviews. Facility observation was executed by using a comprehensive checklist. Structured interviews were conducted with healthcare providers through a universal sampling technique. Qualitative arm included semi-structured interviews with mothers of newborns. These in-depth interviews were performed till the point saturation was achieved in study findings. The study was conducted over a period of three months from July till September 2016. For quantitative part, bio-statistical method that is reporting of descriptive frequencies is performed and data was analyzed using SPSS 19.0 software. Analysis of qualitative data was done manually and codes and themes were generated from findings. Findings: Inadequate supplies, non-functional medical equipment, absence of medicines, shortages of human resource, lack of clinical practices guidelines and knowledge gaps among healthcare providers were identified as factors poorly affecting quality of newborn care. From the mothers\u27 perspective; inappropriate communication and attitude of healthcare providers, delay in response, inappropriate environmental cleanliness, unavailability of logistics, and lack of health awareness for newborn care were the factors that negatively affect quality of facility-based newborn care. Conclusion and Recommendations: It is important that the various factors affecting quality of care become explicit to healthcare providers, health system managers, and policy makers in order to continuously monitor and improve neonatal care provision. In this regard, implementation of standard guidelines for newborn care, overcoming the issue of staff shortage, staff training on essential newborn care, frequent facility audits and overcoming the logistic issues are the key solutions for improving neonatal quality at health facilities