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. 2021 Jul 23;16(7):e0254781.
doi: 10.1371/journal.pone.0254781. eCollection 2021.

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

Manoja Kumar Das  1 , Narendra Kumar Arora  1 , Suresh Kumar Dalpath  2 , Saket Kumar  2 , Amneet P Kumar  2 , Abhishek Khanna  1 , Ayushi Bhatnagar  1 , Rajiv Bahl  3 , Yasir Bin Nisar  3 , Shamim Ahmad Qazi  3 , Gulshan Kumar Arora  4 , R K Dhankhad  5 , Krishan Kumar  6 , Ramesh Chander  4 , Bhanwar Singh  6
Affiliations

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

Manoja Kumar Das et al. PLoS One. .

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.

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Conflict of interest statement

There is no competing interest for the authors. The authors, SD, SK, APK, GKA, RKD, KK, RC, and BS are the officials of Department of Health and Family Welfare, Government of Haryana and were implementing and/or supervising the implementation of the quality improvement interventions in the districts. The authors, RB, YBN and SAQ are staff members/technical advisors of the World Health Organization and were not involved in the implementation or interpretation of the results. The expressed views and opinions in this paper do not necessarily express the policies of the Government of Haryana and World Health Organization.

Figures

Fig 1
Fig 1. The quality management activities implemented during the project.
Note: QI- Quality improvement and QM- Quality management. * Observations in labour room (LR)/antenatal clinic (ANC)/sick newborn care unit (SNCU) focused on the care for women in labour, antenatal care, essential and sick newborn care and hand hygiene at all places. ** The knowledge and skill assessments included respective care for women in labour and essential and sick newborn care in the labour room and SNCUs respectively.
See this image and copyright information in PMC

References

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