Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
Reproductive Health Division, Population Council, New Delhi, India.
PLoS One. 2020 Nov 2;15(11):e0241499. doi: 10.1371/journal.pone.0241499. eCollection 2020.
Female sterilization is the most popular contraceptive method among Indian couples, and the public sector is the major source of sterilization services in the country. However, concerns remain on the quality of services provided, deaths, failures, and complications following sterilization. In this paper, we study the complexities around the quality of care in female sterilization services at public health facilities and identify strategies for improving the measurement of such quality. A better understanding of these issues could inform pragmatic strategies for enhancing quality. This study uses data from the National Family Health Survey (NFHS) 2015-16 and District Level Household and Facility Survey (DLHS) 2012-13. The study is limited to only districts whose data are available in both DLHS 2012-13 and NFHS 2015-16. The methods of analysis include bivariate statistics, Pearson's chi-square test, and two-level mixed-effects logistic regression. We found that the quality of care (QoC) in sterilization service at the public health facilities in India is associated with facility readiness and the socio-economic characteristics of the clients. There is a significant association between household wealth and the QoC received. Our study provides empirical shreds of evidence on the role of structural attributes in delivering quality sterilization services. The spatial analyses revealed the geographies in the country where the QoC and facility readiness are low. Quality should be an overriding priority to establish the credibility of any health care delivery system. It is essential to provide safeguards against adverse events to develop the client's confidence in the services, which is the key to success for any voluntary family planning program like in India.
女性绝育是印度夫妇中最受欢迎的避孕方法，公共部门是该国绝育服务的主要来源。然而，人们仍然对所提供服务的质量、绝育后的死亡、失败和并发症表示担忧。本文研究了公共卫生机构中女性绝育服务质量护理的复杂性，并确定了改善此类质量衡量的策略。更好地了解这些问题可以为增强质量提供切实可行的策略。本研究使用了 2015-16 年全国家庭健康调查（NFHS）和 2012-13 年地区级家庭和设施调查（DLHS）的数据。该研究仅限于其数据在 DLHS 2012-13 和 NFHS 2015-16 中均可用的地区。分析方法包括双变量统计、皮尔逊卡方检验和两级混合效应逻辑回归。我们发现，印度公共卫生设施绝育服务的质量（QoC）与设施准备情况和客户的社会经济特征有关。家庭财富与获得的 QoC 之间存在显著关联。我们的研究提供了有关结构属性在提供优质绝育服务方面的作用的经验证据。空间分析揭示了该国 QoC 和设施准备情况较低的地理区域。质量应该是建立任何医疗保健提供系统可信度的首要任务。必须提供防范不良事件的保障措施，以增强客户对服务的信心，这是像印度这样的任何自愿计划生育计划取得成功的关键。
