title: Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.
abstract: BACKGROUND
  Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals.
  
  
  METHODS
  Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines.
  
  
  RESULTS
  The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments.
  
  
  CONCLUSIONS
  The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden. farzana.islam@oru.se.|Centre for Injury Prevention and Research, Bangladesh (CIPRB), House: B-162, Road 23, Mohakhali DOHS, Dhaka, 1206, Bangladesh. farzana.islam@oru.se.
authors.forename: Farzana
authors.initials: F
authors.lastname: Islam
authors.affiliation: Centre for Injury Prevention and Research, Bangladesh (CIPRB), House: B-162, Road 23, Mohakhali DOHS, Dhaka, 1206, Bangladesh. aminur@ciprb.org.
authors.forename: Aminur
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Centre for Injury Prevention and Research, Bangladesh (CIPRB), House: B-162, Road 23, Mohakhali DOHS, Dhaka, 1206, Bangladesh. halim.ogsb@gmail.com.
authors.forename: Abdul
authors.initials: A
authors.lastname: Halim
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden. Charli.Eriksson@oru.se.
authors.forename: Charli
authors.initials: C
authors.lastname: Eriksson
authors.affiliation: Centre for Injury Prevention and Research, Bangladesh (CIPRB), House: B-162, Road 23, Mohakhali DOHS, Dhaka, 1206, Bangladesh. fazlur@ciprb.org.
authors.forename: Fazlur
authors.initials: F
authors.lastname: Rahman
authors.affiliation: School of Health and Medical Sciences, Örebro University, Örebro, Sweden. koustuv.dalal@oru.se.
authors.forename: Koustuv
authors.initials: K
authors.lastname: Dalal
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001459:Bangladesh; D002662:Child Health Services / Q000592:standards*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D017060:Patient Satisfaction; D011247:Pregnancy; D058996:Quality Improvement / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D013222:State Medicine / Q000592:standards*; D055815:Young Adult