Facility Clinical and System Strengthening through Mentoring Answers the Desperate Cry for a Robust Quality Improvement Strategy in Maternal, Neonatal and Child health Programs: a Northern Karnataka, South India Experience

Presenter: Lloyd Troydon Cunningham, Karnataka Health Promotion Trust

Background: Maternal, neonatal child health (MNCH) remains a global challenge with regional discrepancies. Globally, 27% of neonatal deaths and 20% of maternal deaths occur in India which is preventable and treatable. Bill and Melinda Gates Foundation funded Sukshema’s project baseline assessment showed that Public health facilities of Karnataka’s eight High priority districts (HPD) were equipped with trained staff. But poor knowledge /skill retention to manage maternal and neonatal complications, compounded with under-performing facility systems existed. The project implemented an innovative on-site nurse mentor intervention as a stratified randomized design in Gulbarga and Bellary; two of eight HPDs over one year.

Methodology: 54 intervention and 54 control PHCs were assessed using facility audits and interviews with provider and post-partum women (30 days post-delivery) in 2012 and 2013.  Results covered changes in PHC services, provider knowledge and practices (as verified by clients) over one year.

Results: Difference between intervention and control sites after a year showed improvement in Intervention over Control PHCs. Staff Nurse Knowledge of conducting labour, delivery, AMTSL (p<0.01) and managing maternal complications such as eclampsia (p<0.01) and neonatal complications including birth asphyxia (p<0.01) showed statistical significance. Intervention PHC Laboratories were stocked and staff capable (p<0.01) of conducting syphilis, HIV and proteinuria tests.  Labour rooms had all prescribed equipment (p<0.05) and drugs (p<0.05). For Post-partum haemorrhage, intervention site staff were more likely to mention uterine massage (p<0.01); catheterization (p<0.01); bi-manual compression (p<0.01); raising the legs (p=0.018) and keeping the patient warm (p<0.01). On-site mentoring intervention was scaled up to Karnataka’s eight HPDs and implemented in 25 HPDs of Uttar Pradesh, North India.

Conclusion: PHC staff mentoring enhances knowledge, resolves long-standing drugs, equipment and staff manage maternal and neonatal complications successfully. On-site mentoring provides a promising intervention to the existing need for a highly effective maternal and neonatal care strategy.