What is Quality? Quality of Care Frameworks

  • Jay SatiaEmail author
  • Kavita Chauhan


In this chapter, we present a review of existing frameworks and a comprehensive framework for improving quality of care in family planning. We discuss the two most popularly used frameworks for defining quality of care: Donabedian’s framework in health (Donabedian, 1988), and the Bruce-Jain framework in family planning. Then we briefly describe the National Quality Assurance Programme of the Ministry of Health and Family Welfare (MoHFW), Government of India, implemented by the National Health Systems Resource Centre (NHSRC). We discuss how the Bruce-Jain quality of care framework relates to rights-based programmes. We conclude the chapter with a discussion of what we can learn regarding quality of care in family planning from quality of care improvement in the health sector. Finally, more recent literature discusses the importance of health system functioning and community norms in a programme’s ability to provide quality of care, in essence providing an ecosystem for quality of care improvement interventions to achieve their full potential. Building on this literature, we present a comprehensive framework for improving quality of care.


Quality of care frameworks Quality assurance Ecosystem Health system 


  1. Blanc, S. K., Curtis, S. L., & Croft, T. N. (2002). Monitoring contraceptive continuation: Links to fertility outcomes and quality of care. Studies in Family Planning, 33(2), 127–140.CrossRefPubMedGoogle Scholar
  2. BMGF (Bill & Melinda Gates Foundation), & Duke University. (2015). Workshop on Quality of health care: Measurement and efforts to improve quality. Neemrana Fort-Palace, 30 June–1 July.Google Scholar
  3. Bruce, J. (1990). Fundamental elements of the quality of care: A simple framework. Studies in Family Planning, 21(2), 61–91.CrossRefPubMedGoogle Scholar
  4. Castle, S., & Askew, I. (2015, December). Contraceptive discontinuation: Reasons, challenges, and solutions. New York: Population Council.Google Scholar
  5. Department of Health. (1997). The new NHS: modern, dependable.
  6. Donabedian, A. (1988). The quality of care: How can it be assessed? JAMA, 121(11), 1145–1150.
  7. Germain A. (2014). Discussion note for the ICPD beyond 2014 conference on human rights: Meeting human rights norms for the quality of sexual and reproductive health information and services. In ICPD Beyond 2014 Expert Meeting on Women’s Health: Rights, Empowerment and Social Determinants. 30 September–2 October 2013, Mexico City. Background paper 2b. Accessed on April 5, 2018
  8. Hardee, K., Kumar, J., Newman, K., Bakamjian, L., Harris, S., Rodríguez, M., et al. (2014). Voluntary, human rights-based family planning: A conceptual framework. Studies in Family Planning, 45(1), 1–18.Google Scholar
  9. Accessed October 7, 2016.
  10. IPPF (International Planned Parenthood Federation). (2015). Quality of care framework 2015. London: IPPF.Google Scholar
  11. Jain, A. (2014). The leaking bucket phenomenon in family planning. Champions for Choice, September 9. Accessed January 19, 2018.
  12. Jain, A. (2017). Quality of care in the context of rights-based family planning. New York: Policy brief, Population Council.Google Scholar
  13. Jain, A. K. (1989). Fertility reduction and the quality of family planning services. Studies in Family Planning, 20(1), 1–16.CrossRefPubMedGoogle Scholar
  14. Jain, A. K., Ramarao, S., Kim, J., & Costello, M. (2012). Evaluation of an intervention to improve quality of care in family planning programme in the Philippines. Journal of Biosocial Science, 44(1), 27–41. Scholar
  15. Jhalani, M. (2014). National quality assurance programme. Presentation made during the NHSRC Convention, 2014.Google Scholar
  16. Maxwell, R. J. (1984). Quality assessment in health. British Medical Journal of Clinical Research and Education, 288, 1470–1472.CrossRefGoogle Scholar
  17. McDonald, K. M., Sundaram, V., Bravata, D. M., Lewis, R., Lin, N., Kraft, S. A., et al. (2007, June). Closing the quality gap: A critical analysis of quality improvement strategies (Vol. 7: Care coordination). Technical reviews, No. 9.7. Agency for Healthcare Research and Quality.Google Scholar
  18. MoHFW (Ministry of Health and Family Welfare). (2012). Indian public health standards: Guidelines for community health centres. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India.Google Scholar
  19. MoHFW (Ministry of Health and Family Welfare). (2013, July). A strategic approach to reproductive, maternal, new-born, child and adolescent health (RMNCH+A) in India.Google Scholar
  20. RamaRao, S., & Mohanam, R. (2003). The quality of family planning programs: Concepts, measurements, interventions, and effects. Studies in Family Planning, 34(4), 227–248.Google Scholar
  21. Rodriguez, M., Harris, S., Willson, K., & Hardee, K. (2013). Voluntary family planning programs that respect, protect, and fulfill human rights: A systematic review of evidence. Washington, D.C.: Futures Group.Google Scholar
  22. Satia, J., Chauhan, K., (2015). Urban Health Initiative (UHI): A comprehensive intervention to address family planning needs of the urban poor in Uttar Pradesh. In J. Satia, K. Chauhan, A. Bhattacharya, & N. Mishra (Eds.), Innovations in family planning: Case studies from India. New Delhi: SAGE.Google Scholar
  23. Singh, S., Krishnan, A., & Kaushal, K. (2015). Landscape of QoC in India. Amaltas Research and Development Consulting. New Delhi.Google Scholar
  24. WHO (World Health Organization). (2015). Improving the quality of care for reproductive, maternal, neonatal, child and adolescent health in South-East Asia Region. Geneva: WHO.Google Scholar
  25. WHO (World Health Organization), & UNFPA (United Nations Population Fund). (2015). Ensuring human rights in contraceptive service delivery: Implementation guide. Geneva: WHO, New York: UNFPA.Google Scholar

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© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Indian Institute of Public Health GandhinagarGandhinagarIndia
  2. 2.Public Health Foundation of IndiaGurgaonIndia

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