A Quality Improvement Program for Maternal-Newborn Care Practices around the Time of Birth for High Case Load Private Providers in India?

Session: What is the Local Private Health Sector and Can it Offer Quality Maternal Health Care?

Presenter: Somesh Kumar, Jhpiego

Background: Improving quality of childbirth care (QoCC) is a priority for India. Private sector provides up to 40% of maternity care in some states. Quality improvement in private sector is challenging due to its highly variable nature and unregulated structure.  We present mid-term results of a multi-pronged program to improve QoCC in the private sector using a framework of clinical standards with funding provided by Merck Sharp & Dohme Corp.

Methodology: 120 private facilities, ranging from single provider obstetric clinics to multi-speciality hospitals, were targeted. 27 standards divided into four sections for childbirth care—normal labor & delivery (NLD), managing complications (MC), postnatal care (PNC) and postpartum family planning (PPFP) were developed through multi-stakeholder consultations. These formed the framework for all program tools and quality benchmarks. Facility quality readiness was assessed through observations, client records and interviews. A short skills-based training on essential practices was conducted for health workers. An adapted version of WHO’s Safe Childbirth Checklist helped improve adherence to essential practices. Dashboards were used to monitor quality. FOGSI gave a quality certification and seal to facilities achieving 70% of standards.

Results: Average baseline scores were 39% (NLD 39%, MC 64% PNC 47%, and PPFP 24%). After 8 months of intervention, facility scores rose to 59% (NLD), 69% (MC), and 69% (PNC). Practices such as recording blood pressure (BP) on admission improved from 88% to 97%, temperature recording from 56% to 97%, giving uterotonics for AMTSL from 53% to 77%, and initiating early breastfeeding from 48% to 67%. As of May 2015, FOGSI had certified 30 facilities (15%) that achieved 70% of standards and desires to scale-up the program.

Conclusion: Partnerships with professional organization, customized skill building, post-training mentoring and clinical standards provide a viable option for improving QoCC in the private sector and facilitate implementation at scale.