Stakeholder Perceptions of National Quality Assurance Standards (NQAS) Implementation in Urban Primary Health Centres of Berhampur, Odisha: A Qualitative Study.
DOI:
https://doi.org/10.47203/IJCH.2026.v38i03.008Keywords:
Quality Improvement, Stakeholder Participation, Community Participation, Primary Health Care, Qualitative Research, Patient-Centered CareAbstract
Objectives: To explore stakeholder perceptions and experiences regarding NQAS implementation in UPHCs of Berhampur, Odisha; identify key facilitators and barriers; and propose strategies to strengthen quality improvement initiatives.
Methodology: A qualitative study was conducted between April and September 2023 in selected UPHCs of Berhampur, Odisha. Purposive sampling was used to recruit stakeholders with direct experience of NQAS implementation and service utilization. A total of 38 participants were included, comprising healthcare providers (medical officers, nurses, pharmacists and laboratory technicians), quality assessors and programme managers, a state consultant/UNICEF representative, and patients attending various health services. Data were collected through in-depth interviews and focus group discussions using semi-structured guides. Thematic analysis was performed through open, axial and selective coding. Data collection continued until thematic saturation was achieved and reported in narrative style.
Results: Six major themes emerged: (1) Infrastructure and Resources, (2) Staff Training and Development, (3) Patient-Centred Care, (4) Stakeholder Awareness, (5) Leadership and Management, and (6) Continuous Quality Improvement. Facilitators included leadership commitment, availability of training opportunities, supportive supervision, and recognition of the importance of quality improvement. Major barriers included inadequate infrastructure, overcrowding, staff shortages, irregular training, limited stakeholder awareness, weak patient engagement, and challenges in documentation and monitoring.
Conclusion: Implementation of NQAS in urban primary healthcare facilities is influenced by a complex interplay of organizational, resource-related, and behavioural factors. Strengthening infrastructure, workforce capacity, stakeholder awareness, patient engagement, and continuous quality improvement mechanisms may enhance sustainable implementation of NQAS and contribute to improved quality of care in urban primary health settings.
Downloads
References
References
1. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press; 2001.
2. Ministry of Health and Family Welfare. Operational guidelines for quality assurance in public health facilities. New Delhi: Government of India; 2013.
3. Ministry of Health and Family Welfare. National quality assurance standards for public health facilities. New Delhi: Government of India; 2016.
4. Agyepong IA, Kodua A, Adjei S, Adam T. When solutions of yesterday become problems of today: crisis-ridden decision making in a complex adaptive system—the additional duty hours allowance in Ghana. Health Policy Plan. 2012;27 Suppl 4:iv20-31.
5. Gurung G, Derrett S, Gauld R, et al. Why service users do not complain or have ‘voice’: a mixed-methods study from Nepal’s rural primary health care system. BMC Health Serv Res. 2017;17:81.
6. Chin B, Montana L, Basagaña X. Reliability and validity of a survey to measure implementation of quality assurance standards in Cambodian primary health care facilities. Int J Qual Health Care. 2016;28(1):104-10.
7. Moyegbone JE, Nwose EU, Nwanjei SD, Agege EA, Odoko JO, Igumbor EO. Integration of eye care into primary healthcare tier in Nigeria health system: a case for Delta State. Clin Med Rev Rep. 2020;2(6):1-6.
8. Scott K, George AS, Harvey SA, Mondal S, Patel G, Ved R, et al. Beyond form and functioning: understanding how contextual factors influence village health committees in northern India. PLoS One. 2017;12(8):e0182982.
9. Lekha KS, Ramani S, Joshi H, Verma P, Malhotra S, Puwar T, et al. What enabled the successful implementation of a quality certification initiative in Bhavnagar, Gujarat? A policy analysis case study. PLOS Glob Public Health. 2025;5(1):e0004180.
10. Patil SS, Gaikwad RA, Deshpande TN, Patil SR, Durgawale PM. Gaps in facilities available at community health centres/rural hospitals as per Indian Public Health Standards: a study from Western Maharashtra. J Family Med Prim Care. 2020;9(9):4869-74.
11. Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf. 2012;21(10):876-84.
12. Durrance-Bagale A, Marzouk M, Tung LS, Agarwal S, Aribou ZM, Ibrahim NBM, et al. Community engagement in health systems interventions and research in conflict-affected countries: a scoping review of approaches. Glob Health Action. 2022;15(1):2074131.
13. Feldman SS, Buchalter S, Hayes LW. Health information technology in healthcare quality and patient safety: literature review. JMIR Med Inform. 2018;6(2):e10264.
14. Turner M, Carr T, John R, Ramaswamy R. A scoping review of the use of quality improvement methods by community organizations in the United States, Australia, New Zealand, and Canada to improve health and well-being in community settings. IJQHC Commun. 2022;2(1):lyab019.
15. Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks (CA): Sage Publications; 2017.
Downloads
Published
Data Availability Statement
The datasets generated and/or analysed during the current study are not publicly available due to participant confidentiality but are available from the corresponding author on reasonable request.
Issue
Section
License
Copyright (c) 2026 Madhumita Bhakta (Corresponding Author); Durga Madhab Satapathy, Somen Kumar Pradhan, Jasmin Nilima Panda, Pramila Marandi, Jyotirmayee Mishra, Abhimanyu Behera, Amaresh Sahoo (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
