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This intervention has been possible because of the financial support of the United Nations Population Fund (UNFPA) under the terms of Cooperative Agreement No. UNFPA/India Award IND/03/P21, and by the generous support of American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-98-00012-00 and In-House Project No. 5800.53116. The contents are the responsibility of the FRONTIERS Program and do not necessarily reflect the views of UNFPA and USAID or the United States Government. Any part of this publication may be reproduced without permission for limited distribution provided it is distributed without charge and the Population Council is acknowledged as the source. The Population Council would appreciate receiving a copy of any materials in which the text is used. The National Rural Health Mission (NRHM) of the Ministry of Health and Family Welfare (MOHFW) proposed introducing a Quality Assurance (QA) program for assessing and improving of the quality of services at public sector health facilities. The Population Council and UNFPA jointly developed and tested a QA manual in Gujarat and Maharashtra states to demonstrate that QA can be readily integrated within district level management structures and procedures; subsequently, the QA program has been scaled-up to all 25 districts in Gujarat. Appreciating the potential of this QA model for improving quality of care, the MOHFW decided to pilot test a slightly modified version of the QA tools and manual in six states, including Karnataka and Maharashtra. The revised QA manual also covers a wider service delivery network by including sub-centers and Reproductive and Child Health (RCH) camps. The Population Council, with financial support from UNFPA, provided technical assistance to the states of Maharashtra and Karnataka in implementing the QA program and helped its institutionalization in the district level management. To build the capacity of district officials to undertake QA visits, the Population Council and state authorities organized a series of events to orient and train state and district officials, facility level workers and members of the District Quality Assurance Group (DQAG). In the first round, 89 facilities in Ahmadnagar and 100 facilities in Tumkur were selected for QA visits. As of December 2007, the DQAG had completed the QA assessment in 80 facilities of Ahmadnagar and 100 facilities of Tumkur. Observations by Council staff of the quality of visits indicate that 64 percent were of good quality, about one-third were average, while a …

Institutionalization of quality assurance within district health management: Experiences from Maharashtra and Karnataka