Improving the quality of child health services: participatory action by providers

Bradley, Janet; Igras, Susan

doi:10.1093/intqhc/mzi057

Cited by 38 publications

(62 citation statements)

References 4 publications

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“…Another factor that led to improved satisfaction of the nutrition services during management of sick under-five children included longer consultations. Similar finding has been previously reported [34, 35]. …”

Section: Discussionsupporting

confidence: 93%

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

et al. 2017

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BackgroundIn 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years.MethodsService delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 541 mothers/caregivers of sick children.ResultsStructural readiness to provide nutrition services was higher for ANC compared to management of sick children; 73% of ANC rooms had >5 of the 13 essential items while only 13% of the designated areas for management of sick children had >5 of the 13 essential items. One in five (19%) healthcare providers had received nutrition training through the NNS. Delivery of the nutrition services was poor: <30% of women received all four key antenatal nutrition services, 25% of sick children had their weight checked against a growth-chart and <1% had their height measured. Nevertheless, most mothers/caregivers rated their satisfaction of the service above average.ConclusionsStrengthening the provision of equipment and increasing the coverage of training are imperative to improve nutrition services. Inherent barriers to implementing nutrition services in primary health care, especially high caseloads during the management of sick under-five children, should be considered to identify alternative and appropriate service delivery platforms before nationwide scale up.

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Section: Discussionsupporting

confidence: 93%

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

et al. 2017

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“…The exact methods used were diverse, including the use of clinical audits[22-25], guidelines [26,27], public feedback through ‘scorecards’ [28,29] or a combination of these methods with the addition of specialised task groups and training [30-35]. In all fourteen studies quality measures improved overall, although the results were not uniform.…”

Section: Resultsmentioning

confidence: 99%

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

2013

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ObjectivesEfforts to scale-up maternal and child health services in lower and middle income countries will fail if services delivered are not of good quality. Although there is evidence of strategies to increase the quality of health services, less is known about the way these strategies affect health system goals and outcomes. We conducted a systematic review of the literature to examine this relationship.MethodsWe undertook a search of MEDLINE, SCOPUS and CINAHL databases, limiting the results to studies including strategies specifically aimed at improving quality that also reported a measure of quality and at least one indicator related to health system outcomes. Variation in study methodologies prevented further quantitative analysis; instead we present a narrative review of the evidence.FindingsMethodologically, the quality of evidence was poor, and dominated by studies of individual facilities. Studies relied heavily on service utilisation as a measure of strategy success, which did not always correspond to improved quality. The majority of studies targeted the competency of staff and adequacy of facilities. No strategies addressed distribution systems, public-private partnership or equity. Key themes identified were the conflict between perceptions of patients and clinical measures of quality and the need for holistic approaches to health system interventions.ConclusionExisting evidence linking quality improvement strategies to improved MNCH outcomes is extremely limited. Future research would benefit from the inclusion of more appropriate indicators and additional focus on non-facility determinants of health service quality such as health policy, supply distribution, community acceptability and equity of care.

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“…Other strategies for improving health-care quality can be participatory assessments by users of the health system, team-based problemsolving, and creative engagement of health providers through national quality improvement initiatives. 25,[27][28][29] As in all assessments that observe provider performance, the presence of observers may have led the providers in our study to alter their usual manner of working. This is illustrated by a study in Benin.…”

Section: Discussionmentioning

confidence: 99%

Trends in the quality of health care for children aged less than 5 years in Afghanistan, 2004–2006

Edward¹,

Dwivedi²,

Mustafa³

et al. 2009

Bull World Health Org

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Improving the quality of child health services: participatory action by providers

Cited by 38 publications

References 4 publications

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

Quality of nutrition services in primary health care facilities: Implications for integrating nutrition into the health system in Bangladesh

Do Strategies to Improve Quality of Maternal and Child Health Care in Lower and Middle Income Countries Lead to Improved Outcomes? A Review of the Evidence

Trends in the quality of health care for children aged less than 5 years in Afghanistan, 2004–2006

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