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In India during last decade several policies and programmes have tried to accelerate provision of essential maternity services. National Rural Health Mission (NRHM), health sector reform program, launched in 2005, primarily aims at health system strengthening and reducing regional imbalances. Study assesses facilitating factors and challenges in providing quality delivery care and generates context-specific implementation lessons in three diverse states in India. Thirty-three in-depth, semistructured interviews were conducted with policy and program representatives. The analysis presented is qualitative and descriptive. Analysis shows that NRHM has infused new life in terms of infrastructure improvements, upgrading lower-level facilities but challenges remain like inadequate human resources, non-utilization of allocated funds and poor monitoring. Strategies have been devised to overcome bottlenecks through task-shifting and quality monitoring. Though the emphasis is on strengthening the structural aspect of care but to complete the whole quality of care cycle, equal emphasis is needed on process of care.
Health sector reform, India, Institutional delivery, Polices, Programme, Quality of care