Skip to main content

Quality of Care at Public Health Institutions: Identifying Gaps

  • Chapter
  • First Online:
Towards Newborn Survival
  • 32 Accesses


Facility births in Bihar have nearly doubled over the last decade, specifically with the implementation of NRHM and its introduction of financial schemes. The unprecedented rise in institutional births, however, has not percolated down sufficiently to reduce adverse birth outcomes. It appears that efforts to increase facility birth, without a corresponding improvement in the quality of care, do not offer much of an opportunity to reduce newborn deaths. This underscores the quality of institutional care that constitutes a major indicator for newborn survival. The present chapter provides a situational analysis of the quality of services around childbirth by emphasising two aspects: Patients’ satisfaction with the services at the institutions and the provision of the services as per the norms set up. The evidence on the ground shows that the poor quality of care at facilities is associated with long waiting times, inappropriate staff behaviour, inadequate facilities, poor counselling on postnatal care, and a lack of ambulance services. The public health system of the state should address these institutional shortcomings so as to improve the quality of care and, consequently, newborn survival.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 49.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions


  • Akachi, Y., & Kruk, M. E. (2017). Quality of care: measuring a neglected driver of improved health. Bulletin of the World Health Organization, 95(6), 465.

    Article  Google Scholar 

  • Aldana, J. M., Piechulek, H., & Al-Sabir, A. (2001). Client satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization, 79, 512–517.

    Google Scholar 

  • Barnett, B. (1995). Women’s views influence use. Network (Research Triangle Park, NC), 16(1), 14–18.

    Google Scholar 

  • Donabedian, A. (1980). Basic approaches to assessment: structure, process and outcome. The Definition of Quality and Approaches to Its Assessment: Explorations in Quality Assessment and Monitoring, 1, 77–128.

    Google Scholar 

  • Fisher, A. W. (1971). Patients’ evaluation of outpatient medical care. Academic Medicine, 46(3), 238–44.

    Article  Google Scholar 

  • Gabrysch, S., Nesbitt, R. C., Schoeps, A., Hurt, L., Soremekun, S., Edmond, K., … Campbell, O. M. (2019). Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials. The Lancet Global Health, 7(8), e1074–e1087.

    Article  Google Scholar 

  • Graham, W., Woodd, S., Byass, P., Filippi, V., Gon, G., Virgo, S., ... & Singh, S. (2016). Diversity and divergence: the dynamic burden of poor maternal health. The Lancet, 388(10056), 2164–2175.

    Article  Google Scholar 

  • Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., … Pate, M. (2018a). High-quality health systems in the Sustainable Development Goals era: time for a revolution. The Lancet Global Health, 6(11), e1196–e1252.

    Article  Google Scholar 

  • Kruk, M. E., Kujawski, S., Mbaruku, G., Ramsey, K., Moyo, W., & Freedman, L. P. (2018b). Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy and Planning, 33(1), e26–e33.

    Article  Google Scholar 

  • Nilsson, I. M., Kronborg, H., Knight, C. H., & Strandberg-Larsen, K. (2017). Early discharge following birth—What characterises mothers and newborns?. Sexual & Reproductive Healthcare, 11, 60–68.

    Article  Google Scholar 

  • Prinja, S., Manchanda, N., Mohan, P. et al. (2013). Cost of neonatal intensive care delivered through district level public hospitals in India. Indian Pediatr 50, 839–846.

    Article  Google Scholar 

  • Rance, S., McCourt, C., Rayment, J., Mackintosh, N., Carter, W., Watson, K., & Sandall, J. (2013). Women’s safety alerts in maternity care: is speaking up enough?. BMJ Quality & Safety, 22(4), 348–355.

    Article  Google Scholar 

  • Randive, B., Diwan, V., & De Costa, A. (2013). India’s conditional cash transfer programme (the JSY) to promote institutional birth: is there an association between institutional birth proportion and maternal mortality?. PloS One, 8(6), e67452.

    Article  Google Scholar 

  • Rural Health Statistics Report 2019–20, National Rural Health Mission, Ministry of Health and Family Welfare, Government of India.

    Google Scholar 

  • Van der Gaag, J. (2010). From child development to human development. In Development and Prevention of Behaviour Problems (pp. 231–242). Psychology Press.

    Google Scholar 

  • Williams, B. (1994). Patient satisfaction: a valid concept?. Social Science & Medicine, 38(4), 509–516.

    Article  Google Scholar 

  • World Health Organization. (2016). Standards for improving quality of maternal and newborn care in health facilities.

    Google Scholar 

  • World Health Organization. (2005). The World health report: 2005: make every mother and child count. World Health Organization.

    Google Scholar 

  • Zaslavsky, A. M., Hochheimer, J. N., Schneider, E. C., Cleary, P. D., Seidman, J. J., McGlynn, E. A., … Epstein, A. M. (2000). Impact of sociodemographic case mix on the HEDIS measures of health plan quality. Medical Care, 981–992.

    Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mahapatro, S.R. (2022). Quality of Care at Public Health Institutions: Identifying Gaps. In: Towards Newborn Survival. Palgrave Macmillan, Singapore.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Palgrave Macmillan, Singapore

  • Print ISBN: 978-981-19-3416-2

  • Online ISBN: 978-981-19-3417-9

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics