Utilization of quality assessments in improving adolescent reproductive and sexual health services in rural block of Maharashtra, India

Sanjay L. Chauhan, Beena N. Joshi, Neena Raina, Ragini N. Kulkarni


Background: The present study was conducted with an objective to evaluate the quality of ARSH services; assess if these services met the National Standards of care and to utilize periodic program improvement recommendations through the WHO - quality assessment (QA) tools. Quality of ARSH services at twenty public health facilities in a rural block of a state in India were assessed using WHO-QA tools with a pre-test post-test interrupted time series design.

Methods: Seven standards of care addressing provision of quality ARSH services (Standard I-IV); demand generation for these services (V-VI); and management information system (Standard VII) were assessed using WHO-QA tools for five years (2009-2014). Data analysis was done using Excel scoring template developed jointly with WHO. Scores were given for each standard and to each facility.

Results: Periodic interventions resulted in improving the average facility score from 27% to 83% and overall standards score from 28% to 81% at baseline and endline survey respectively. The average scores for Standards I-IV improved from 43% 86%; for standards V–VI from 3% to 66% while for standard VII from 16% to 92% at baseline and endline survey respectively.

Conclusions: Appropriate QA and periodic evidence-informed program inputs improved the quality and utilization of ARSH services. However, community outreach activities continued to be challenging. The assessment demonstrated feasibility and usefulness of using the WHO-QA tools to monitor and improve the quality of ARSH services.


Quality assessment, ARSH, Standards, Quality of care, India

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