Jaipur, India, November 2008. When was the last time you visited a public hospital in India and wondered when the floor had last been cleaned? Or why the dark red betel stains in the corners could not be painted over? And, of course, why there was no doctor on site and no one to guide you? Ask any of the patients waiting in the interminably long lines whether they know what their rights are and you get blank looks.

The course was held for 40 senior and mid-level health officials.

Most officials are well aware of this situation and agree that the quality of public health services in India leaves much to be desired. In theory, the government provides health care to all its citizens through an extensive network of primary, secondary and tertiary facilities that reach even remote villages. In practice however, this health network is beset with deteriorating infrastructure, low quality care and doctor absenteeism that often deters the poor from receiving basic health services.

Health care management is an evolving concept in India. At present, only a few universities, medical and business schools offer programs which focus on quality management. And yet, all students and practitioners of health care should know the basics of providing quality care - how to make patients comfortable, direct them to the right doctor, and see to it that they are satisfied with the services they receive.

The good news is that this problem has been recognized by many public health officials in India - particularly in the states which have the primary responsibility for the delivery of health services. “When we talked to state health officials and asked them in which areas we should offer new training courses for practicing health officials, ‘quality management of care’ came out amongst the top three topics” says Dr. Deoki Nandan, Director of the National Institute of Health and Family Welfare (NIHFW), the government’s apex training institute for health officials.

He referred to training needs assessments for health personnel carried out jointly in October 2007 by NIHFW and the World Bank Institute (WBI) which is the training and capacity development arm of the World Bank. WBI, NIHFW and the Government of India have been working on a larger capacity development initiative on health system policy and management for the past three years. The quality improvement initiative is part of this larger program.

“As a result of the needs assessments, NIHFW and WBI worked with a group of Indian and international experts in the field of quality management to develop a 6-day course on Improving Quality of Care in the Health Sector.  We partnered with the German Technical Cooperation (GTZ) which has been working in this area for many years in India and has been supporting quality improvement initiatives in West Bengal and Himachal Pradesh. GTZ also contributed significant funding to get this course going”, explains Alexandra Humme, WBI task team leader for the program.

Operating room at a district-level public hospital in India

Following a preparatory workshop in June 2008, the first course was held in November 2008 for 40 senior and mid-level health officials. These included hospital managers, district health managers and faculty of medical colleges from six Indian states. The participants were equipped with practical ways and means to improve the quality of care provided in their institutions.  They learned about the principles of quality management, management concepts and tools, health care standards in India and abroad, legislative frameworks for quality, client orientation and patient satisfaction, and evaluating the quality of care provided.

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Contributed by Alexandra Humme, World Bank Institute Office: New Delhi

• For more information, read about the previous event in May 2008