Study on quality assessment of child health care services in a district of Assam

Introduction: Children less than five years of age is a critical indicator of the wellbeing of children. In order to reduce infant as well as under-five mortality rate of children, Govt of India has initiated different health programmes as well as recommended Indian Public Health Standards for health care facilities to provide quality health care. Objective: To assess the quality of child health care services at health care facilities at primary and secondary level. Methodology: A cross-sectional study had been conducted at CHCs, PHCs and S/Cs in Kamrup district of Assam. The data had been collected by quality assessment checklists and exit interview with the clients availing the child health services at the health care facilities. Results: The quality of child health care services was assessed by using a system approach-inputs, process and outputs. There were only 66.66% availability of Obstetrics & gynaecology specialist and paediatrician. Physician were available in 33.33% of CHCs. The availability of trained personals was found to be inadequate in all the CHCs and PHCs. Most of the equipments and supplies were available in all the health care facilities. The child health care activities in areas of immunization and cold chain maintenance was found to be satisfactory. Conclusion: The quality of child health care services was found to be average at primary and secondary level.


Introduction
Each year 27 million children are born to India. Around ten percent of them do not survive to 5 years of age. India contributes to 25 percent of the over 6.9 million under-five deaths occurring worldwide every year. The quality of human resources of any country is largely determined by the quality of the child development services Patient's satisfaction is an important part of health care. It is also a measure of quality of care. Avedis Donabedian (1966;1980) [5] described quality as including: structure (viewed as the capacity to provide high quality care), process (often termed as performance) and outcome.
As studies on child health care quality was not done previously in this region, the present study had been proposed to be carried out in Kamrup district of Assam to assess the quality of child health care services at primary and secondary level and to identify the weakness so that the appropriate measures might be taken to provide responsive and effective care to every child.  Based on the number of positive responses, services were categorized as 'very good' 10-12points graded as A; 'good' 7-9points as B; 'average'4-6points graded as C; and 'poor' 1-2points graded as D.

Methodology
The data had been collected by exit interview in the OPDs using pretested & predesigned structured schedule. The child health services include ARI, diarrhoea, immunization and others. Three clients were interviewed for each service area in each of the facility. Thus, a total 96 clients were interviewed for client satisfaction.

Category
Grade Score    The advice on immunization and follow-up visits as well as updated/ completed immunization card was also found to be 100% at all the S/Cs. The drop out rates were also traces by the ANM. Anganwadi workers and ASHA also were found to be participated during the immunization sessions at all the Sub-centres.         Aswar et al [12] also reported mothers were not knowing the importance of immunization and immunization schedule. Perrey H [13] et al 1998 in their study for assessment of quality of immunization service found that the knowledge of immunization schedule of health worker was good.
Steer land PH et al (1999) 12 in their study found that immunization cards were absent in many of the centres in Bangladesh.
Availability of an immunization document is the best proof of the child being immunized K Suresh (2000) [19]. Cutts F T et al 1990, [15] in their study observed that only half of the clients whose children were vaccinated were informed about the vaccine reactions or about the name of the vaccine received.
Full course of potent vaccines given at right age and at right interval, by right technique with a valid documentation constitutes the quality criteria for vaccination services (Tapare VS, Borle PS 2006) [16].
At the S/cs, the immunization service delivery also found to be satisfactory. The advice on immunization and follow up visits as well as updated immunization card was also found to be 100% at all the S/cs. The drop out rates were also traced by the ANM. Anganwadi workers and ASHA also were found to be participated during the immunization sessions at all the Sub-centres. In the present study, the availability of equipments and supplies such as BP apparatus and stethoscope, infant and adult weighing machine were available in all the CHCs and PHCs. shortages of needles in two out of seven centres and syringes in four out of seven centres in Phillipines. The assessment of client satisfaction is inevitably subjective, because of educational, social, economic and linguistic differences between health professional and their clients.
The perception of quality varies from person to person according to individual's knowledge, values and resources (Humberto de Novaes, 1993). In this study, most of the patients were satisfied with child health care services at the health care facilities. By B S Akoijam et al (2007) [21] reported that most of the patients were satisfied with overall care received by the health care provider at the tertiary care hospital.
By Banerjee B (2003) [20] in their study found that the main deficiency regarding days and timing of the availability of specific services and the location of different service outlets within the centre by the clients.

Conclusion
The present study concluded that the quality of child health services were average at CHCs, PHCs and S/C level. The child health care activities that observed at the CHCs and PHCs in areas of immunization services and cold chain maintenance was found to be satisfactory.

Recommendation:
Based on the studies the following findings are recommended--The infrastructure gap of S/C,PHC,CHC should be met.
-Available untrained manpower should be trained and vacancy should be filled-up.
-There must be periodical orientation of medical as well as paramedical staffs at the health care facilities.