A policy analysis of quality-of-care policy of Gujarat state, India

Ensuring high-quality healthcare services is crucial. In low- and middle-income countries, poor-quality care is estimated to cause 5.7 to 8.4 million deaths annually, accounting for approximately 15% of all deaths. Also, it becomes impossible to achieve the desired health outcome without quality healthcare services. In this context, the need for a comprehensive Quality of Care (QoC) policy tailored to specific geopolitical context has been emphasized world-wide. This study aimed to analyse the Gujarat Quality of Care Policy to understand and document the policy's development process, its content, and implementation. This qualitative study includes two tracks: (1) A narrative synthesis of QoC Policy analysis using the READ approach, combined with a review of office records, to explore its development and understand the strategy’s background. (2) In-depth interviews with stakeholders to gather insights on the policy’s content, key drivers, barriers, and challenges in its development and state-level implementation. The Gujarat QoC Policy was initiated with stakeholder mapping involving a diverse, multi-sectoral group. It was guided by the World Health Organization National Quality Policy and Strategy (WHO-NQPS) and Lancet’s Global Health Commission’s High-Quality Systems Frameworks. The policy content was shaped by priority needs, identified gaps, and core elements of quality of care. It addressed interventions at micro, meso, and macro levels, categorizing indicators into input, process, output, and outcome. Gujarat’s Quality of Care Policy adopts an evidence-based approach with extensive stakeholder engagement. Broader inclusion of key actors could strengthen its impact. Successful implementation depends on adequate resources, capacity building, and robust monitoring. Future research should evaluate implementation challenges, particularly at the grassroots level and in the context of private sector dominance in the state.