Adherence to essential practices following strategic skills building and onsite structured mentoring in labour rooms, Maharashtra, India

Bijali SinhaProgram Officer, Jhpiego, Mumbai

47.0%

72.9%82.8%

92.0%

0%10%20%30%40%50%60%70%80%90%

100%

DLHS-3 (2007) CES (2009) HIMS (2012) DLHS-4 (2012-2013)

Prop

ortio

n of

live

birt

hsOur rates of institutional birth increased after

Janani Suraksha Yojna

>75% increase in 5 years

2

301254

212178 167149

130104 87

68

0

50

100

150

200

250

300

350

2001-03 2004-06 2007-09 2010-12 2011-2013

Maternal Mortality Rate

India Maharashtra

Trends In India & Maharashtra

58 57 55 53 50 47 44 42 4236 35 34 31 31 28 25 25 24

0

10

20

30

40

50

60

70

2005 2006 2007 2008 2009 2010 2011 2012 2013

Infant Mortality Rate

India Maharashtra

IMR reduced by 29% in 5 years MMR reduced by 35% in 5 years

Simple, Evidence-Based Practices Save Lives

§  AMTSL has been shown to reduce the incidence of PPH (>1/3 of maternal deaths in India) by up to 66%

§  Use of MgSO4 in severe pre-eclampsia has been shown to reduce progression to eclampsia by 58% & reduces deaths by up to 45%

§  Use of the partograph to monitor labor/identify complications early has been shown to reduce early neonatal deaths by 40%

§  Antibiotics for preterm premature rupture reduces the incidence of infections by 32%

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The Program…Jhpiego and Government of Maharashtra, with support from John D. and Catherine T. MacArthur Foundation, developed a program to improve the quality of care in labour rooms of selected facilities in Maharashtra since January 2013.

Geographical Coverage

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Objectives

Objective 1: Support targeted improvements in highest impact clinical practices in the labor room.

Objective 2: Strengthen select, targeted midwifery competencies of the providers to enable provision of high-quality, respectful intra- & postpartum services at the facilities.

Objective 3: Support the development of an enabling environment at the facilities.

Objective 4: Strengthen the performance measurement capacity at the facilities to enable them to monitor, report and recognize quality achievements.

Standards-Based Management and Recognition: A Process for Improving the Quality of Health Services

StandardsAreas No. of Standards  

Normal Labor, Childbirth and Immediate Newborn Care   18  

Management of Antenatal, Intrapartum and Postpartum Complications   7  

Postpartum Care for a Woman and the Neonate   8  

Infrastructure and Human Resources   7  

Total   40  

The standards in the tools tell providers not only “what to do” but also “how to do”. Based on GoI guidelines- SBA, NSSK, Infection Prevention, BEmOC

Clinical standards for improving quality care in labour rooms

Facility Approach

Periodic Assessment

Implementation of Standards

Clinical Skills Standardization

Update

Baseline Assessment

Orientation to Standards Mentoring

Rewards & Recognitions

ImplementationClinical Skill Standardization

§  2-day Clinical Skill Standardization workshop

§  Based on labour room delivery practices, namely-Plotting partograph, 2nd and 3rd stage of labour management, newborn resuscitation, PPH, eclampsia management

§  Involves all the labour room staff through objective structured clinical evaluation

§  365 labour room staff trained to date

Post-Training Mentoring Visit§  Followed by post-training mentoring

visit§  Hands on mentoring provided to LR

staff§  Translation of skills into practices§  Skill correction

§  Need-based, short onsite trainings§  Hands on & onsite training for 300

labour room staff to date

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Trends of essential practices during delivery

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Practices initiated after clinical standardization workshop

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Plotting simplified partograph

Newborn resuscitation - maintaining golden minute

Performing AMTSL

Conclusion

§  Structured and focused clinical standardization workshop followed by focused mentoring visits help in adherence to essential labour room practices to improve quality care for mother and newborn.

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Thank you

Not miles but few steps to walk to reach every mother and newborn to improve quality of care during intra and immediate post partum period.

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