Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

Abstract

Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

Effect of a perinatal care quality improvement package on patient satisfaction: a secondary outcome analysis of a cluster-randomised controlled trial

“…With increased knowledge and continuous discussions concerning care of the mothers and newborn, healthcare workers might also get more sensitised and empathic towards their patients. A recent implementation study conducted in India, also adopting the PDSA approach and facilitation to improve quality of care, could show improvements in satisfaction among women who had recently given birth similar to our results 26…”

“…Though we could see an increased satisfaction after the intervention, the proportion of satisfied women both before and after was low. This despite that women tend to report more satisfied with care if interviewed early after childbirth, biased by social desirability and the joy of having a healthy baby29 and previous studies of satisfaction in Nepal and India has shown higher levels 26 30 31. We do not know why the women were not more satisfied with care but some factors can be considered.…”

“…This despite that women tend to report more satisfied with care if interviewed early after childbirth, biased by social desirability and the joy of having a healthy baby 29 and previous studies of satisfaction in Nepal and India has shown higher levels. 26 30 31 We do not know why the women were not more satisfied with care but some factors can be considered. First, we sought to reduce the influence of social desirability by our definition of satisfaction (overall satisfaction combined with whether to recommend the facility to a friend).…”

“…A recent implementation study conducted in India, also adopting the PDSA approach and facilitation to improve quality of care, could show improvements in satisfaction among women who had recently given birth similar to our results. 26 …”

Investigação de marcadores de percepção de violência obstétrica por gestantes

“…Dados divulgados pelo Ministério da Saúde, em 2015, indicam que o índice de parto cesariano chega a 56%, portanto, se aproximando aos dados obtidos em nossa investigação (Leite et al, 2022). Notadamente, esta taxa varia entre os sistemas público 40% e privado de saúde 85% (Das et al, 2021). Essa realidade é considerada preocupante visto que a recomendação da Organização Mundial da Saúde é de uma taxa de cesarianas variando entre 10 a 15%.…”