Table 2 Highlights of policy influences on MNHFP + A quality of care in India

1991

Structural Adjustment Programme launched in the economy – curtailed public social expenditure; leads to rise in private sector health investment in India

Quality concerns voiced on growing unregulated private health sector

1992

Launch of Child Survival and Safe Motherhood Programme; setting up First Referral Units for emergency obstetric care

1992–93

First National Family Health Survey held in India – collects in-depth data on maternal and child health

1994–96

The UN Conferences on Population and Development (Cairo, 1994) and Women and Development (Beijing, 1996) held – rise of reproductive rights movement

India adopts target-free and RCH approach in 1995; RCH programme introduces integrated MCH, family planning and reproductive health services

Quality concerns voiced increasingly but no action strategies formulated

2000–2005

National Population Policy (2000) outlines RCH strategy & sets specific IMR & MMR reduction goals

Quality focus in tenth and eleventh plans with strategies for quality assurance & appraisal, including setting up of National Accreditation Board for Hospitals and Healthcare Providers (NABH).

2005

NRHM/RCH-II launched, leading to expanded funding and decentralized programme implementation

Quality focus and action strategies in both programmes along with regular monitoring & feedback mechanisms.

Quality initiatives include Indian Public Health Standards for quality assurance in primary care; Quality Assurance Committees at district/State level under RCH-II & assistance to states by NABH for quality certification.