Research Department, Public Health Foundation of India, Gurugram, Haryana, India.
PLoS One. 2018 Sep 27;13(9):e0204607. doi: 10.1371/journal.pone.0204607. eCollection 2018.
Improving quality of maternal healthcare services is key to reducing maternal mortality across developing nations, including India. Expanding access to institutionalized care alone has failed to address critical quality barriers to safe, effective, patient-centred, timely and equitable care. Multi-dimensional quality improvement focusing on Person Centred Care(PCC) has an important role in expanding utilization of maternal health services and reducing maternal mortality.
Nine public health facilities were selected in two rural districts of Uttar Pradesh(UP), India, to understand women's experiences of childbirth and identify quality gaps in the process of maternity care. 23 direct, non-participant observations of uncomplicated vaginal deliveries were conducted using checklists with special reference to PCC, capturing quality of care provision at five stages-admission; pre-delivery; delivery; post-delivery and discharge. Data was thematically analysed using the framework approach. Case studies, good practices and gaps were noted at each stage of delivery care.
Admission to maternity wards was generally prompt. All deliveries were conducted by skilled providers and at least one staff was available at all times. Study findings were discussed under two broad themes of care 'structure' and 'process'. While infrastructure, supplies and human resource were available across most facilities, gaps were observed in the process of care, particularly during delivery and post-delivery stages. Key areas of concern included compromised patient safety like poor hand hygiene, usage of unsterilized instruments; inadequate clinical care like lack of routine monitoring of labour progression, inadequate postpartum care; partially compromised privacy in the labour room and postnatal ward; and few incidents of abuse and demand for informal payments.
The study findings reflect gaps in the quality of maternity care across public health facilities in the study area and support the argument for strengthening PCC as an important effort towards quality improvement across the continuum of delivery care.
改善孕产妇医疗服务质量是降低发展中国家（包括印度）孕产妇死亡率的关键。仅扩大机构化护理的覆盖面未能解决安全、有效、以患者为中心、及时和公平护理方面的关键质量障碍。注重以人为本的护理（PCC）的多维质量改进在扩大孕产妇保健服务的利用和降低孕产妇死亡率方面发挥着重要作用。
在印度北方邦（UP）的两个农村地区选择了 9 家公共卫生机构，以了解妇女分娩的经历，并确定产妇保健过程中的质量差距。使用特别参考 PCC 的检查表对 23 例无并发症的阴道分娩进行了 23 次直接、非参与性观察，记录了 5 个阶段（入院、分娩前、分娩、分娩后和出院）的护理质量提供情况。使用框架方法对数据进行了主题分析。在分娩护理的每个阶段都记录了案例研究、良好实践和差距。
产妇病房的入院通常很及时。所有分娩均由熟练的医护人员进行，至少有一名工作人员随时待命。研究结果分为两个广泛的主题进行讨论：护理的“结构”和“过程”。尽管大多数设施都提供了基础设施、用品和人力资源，但在护理过程中仍存在差距，特别是在分娩和分娩后阶段。关注的主要领域包括患者安全受损，例如手卫生差、使用未消毒的器械；临床护理不足，例如劳动进展常规监测不足、产后护理不足；产房和产后病房部分隐私受损；以及一些虐待和要求支付非正式款项的事件。
研究结果反映了研究区域内公共卫生设施的产妇保健质量存在差距，并支持加强以人为本的护理作为改善分娩护理全过程质量的重要努力的论点。
