Barriers to the Quality of Care: The Experience of Auxiliary Nurse-Midwives in Rural Maharashtra

Abstract

The notion of quality in the public health system is becoming increasingly an issue for policymakers and planners in India. The Eighth Five-Year Plan identified the poor quality of family welfare services as one of the factors
hindering the achievement of a lower birth rate (GOI, Planning Commission 1992, p. 333). More recently, the Indian government has outlined elements of a quality - oriented, or quality - focused, approach in the Reproductive and Child Health Programme (GOI, MOHFW 1996).

As a concept, quality is attuned to the needs and satisfaction of the users of health services. By that token, a quality approach lends itself easily to the fulfillment of desired outcomes, whether these are measured by better health status or improved demographic indicators. Such a result is possible only when quality efforts are sufficiently backed up by adequate and rationally distributed infrastructure and material resources. The relationship between quantity and quality is best expressed at the ground level. This chapter reflects these ground realities from the perspective of auxiliary nurse-midwives (ANMs) in Maharashtra.