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Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Injury Prevention and Research, Bangladesh (CIPRB), Road 23, Mohakhali DOHS, Dhaka, Bangladesh .
Centre for Injury Prevention and Research, Bangladesh (CIPRB), Road 23, Mohakhali DOHS, Dhaka, Bangladesh .
Centre for Injury Prevention and Research, Bangladesh (CIPRB), Road 23, Mohakhali DOHS, Dhaka, Bangladesh .
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0003-0185-0851
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2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, 237Article in journal (Refereed) Published
Abstract [en]

Background: Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals.

Methodology: Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines.

Results: The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments.

Conclusion: The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2015. Vol. 15, 237
Keyword [en]
Bangladesh, clients' satisfaction, healthcare providers' perception, maternal and neonatal health, quality of healthcare
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Medical Care Research
Identifiers
URN: urn:nbn:se:oru:diva-45294DOI: 10.1186/s12913-015-0918-9ISI: 000356584000001PubMedID: 26084893Scopus ID: 2-s2.0-84935856544OAI: oai:DiVA.org:oru-45294DiVA: diva2:842847
Available from: 2015-07-23 Created: 2015-07-20 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
Open this publication in new window or tab >>Quality Improvement System for Maternal and Newborn Health Care Services at District and Sub-district Hospitals in Bangladesh
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. 123 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 64
Keyword
Bangladesh, hospital, maternal health, newborn health, quality improvement
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-48416 (URN)978-91-7529-123-9 (ISBN)
Public defence
2016-03-18, Långhuset, L153, Örebro universitet, Fakultetsgatan 1, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2016-02-19 Created: 2016-02-19 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

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