This finding makes it clear that improving communication and transportation infrastructure, training and supervision alone cannot overcome all barriers to providing quality care.
Other studies have highlighted the important role that managers can play in job satisfaction [ 23, 28].While there is some evidence that improved infrastructure and supportive supervision improve retention [ 29, 30], it is worth noting that infrastructural problems themselves limit the amount and frequency of supervisory visits to remote areas.
The objective is to describe the quality of process of care, including aspects as infrastructure, equipment, training and supervision, and including real time observation of SBA performances during the intrapartum period.
These common factors are: CHW's education, distance of residence from work place, socio-cultural status, training, role clarity, job skills, infrastructure and job support, supervision, incentives, clarity on career progression, affiliation to a government department and perceptions and myths within the client community (1).
Based on the analysis of these factors and lessons learnt from this study, the two concerned departments (health and DWCD) should prioritise corrections in the following areas: ASHA selection, role clarity, training, infrastructure, monitoring, supervision, and incentive systems.
Selecting the HCs randomly from each sub-city has improved representation, as all HCs under a sub-city would have similarity in infrastructure, logistics, in-service training and supervision.
However, 35% of all IT representatives were also concerned about the cost of supervision, infrastructure and IT support that would be required if more computers with internet access were made available to patients.
These variable results have been ascribed to implementation challenges, particularly poor quality and low availability of some services due to weak technical capacity, inadequate infrastructure and management capacity, and poor monitoring and supervision [ 10, 11].
Poor infrastructure, limited training opportunities, high workloads, inadequate supplies and supervision, undisclosed job locations for public sector jobs, and most recently political instability all continue to be barriers to successful rural recruitment and retention.
Furthermore, health system strengthening through upgrading of infrastructure and services, an enhanced focus on monitoring, feedback and supervision, continued professional trainings and involving communities to demand for quality services is likely to result to overall improvements in QoC.
