Date of Award

1-10-2021

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Mairaj Shah

Second Advisor

Dr. Maryam Huda

Third Advisor

Dr. Imran Naeem

Department

Community Health Sciences

Abstract

Background: Nutrition care is crucial for the improvement of quality of life, decrease in mortality, morbidity, and achievement of positive health outcomes in hospitalized patients. The nutrition service requirements are becoming more complex day by day with the changing dynamics of patients’ needs and demands. Multiple studies have been done to assess the quality of public health, food services, food quality including food labeling. However, no local work has been done to assess the quality of clinical nutrition services delivery in Pakistan. Quality indicators help in developing future strategies based on current practice evaluation and past performances.
Objectives: 1. To measure the quality of nutrition service delivery in inpatient and outpatient settings in public and private sectors tertiary hospitals by using Nutrition Service Delivery Assessment (NSDA) tool from July to October 2021 2. To identify the multifaceted factors that affect the quality of nutrition services through Focus Group Discussions from July to October 2021
Methodology: A mixed methodology was used to conduct the study with a cross-sectional study design. The sample consists of a total of 06 Nutrition Dept. of Tertiary Care Hospital of Karachi, Pakistan including 3 privates, 02 semi-private, and 01 government hospital. Nutrition service delivery assessment tool (validated tool) was used for quantitative data collection including ““General Health Facility Information, Human Resources Trained in Nutrition and Quality Improvement, Provision of Nutrition Services, Community Linkages, Quality Improvement, Materials and Supplies, Monitoring and Evaluation for Nutrition”” whereas focus group discussion was conducted for the qualitative part of the study. 01 FGD with 4-6 participants in each hospital was conducted along with a health facility survey questionnaire, filled by in charge nutrition department. Descriptive data analysis was done for quantitative data and thematic data analysis was done for qualitative data. After doing thematic analysis, Pareto analysis was also done to prioritize factors affecting the quality of clinical nutrition services.
Results and Discussion: The results show that the quality of clinical nutrition services in tertiary care hospitals of Karachi ranks between poor and fair in multiple aspects however also ranks good in some competencies including general health facility information and provision of nutrition services. The results also show some factors that are affecting the delivery of quality services including; staff shortage, staff overworked, lack of resources, management’s understanding of clinical nutrition intervention and importance, inadequate utilization of resources, communication gap between dietitians and physicians, and low salaries. The dietitians to patient ratio also indicate a huge gap of human resources specifically in the government sector with 1:100 followed by 1:34 in the private sector and 1: 58 overall.
Conclusion: The overall quality of nutrition services ranks between fair and poor in multiple competencies, for both Private and public sector hospitals. The vital few causal factors that need to be addressed on a priority basis to ensure quality nutrition care services delivery include; Staff shortage, Staff overworked, and Lack of resources such as materials and supplies. Additionally, the realization of nutrition services as a distinct entity was poor among the management of these hospitals.

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