Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3 months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

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Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

Health Services Insights ◽

10.4137/hsi.s11226 ◽

2013 ◽

Vol 6 ◽

pp. HSI.S11226

Author(s):

Enakshi Ganguly ◽

Bishan S. Garg

Keyword(s):

Health Care ◽

Primary Health Care ◽

Primary Health Care System ◽

Job Descriptions ◽

Continuous Training ◽

Primary Health ◽

Primary Health Centres ◽

Quality Assurance Mechanism ◽

Health Centres

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

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Trends in the development of psychiatric services in India

Psychiatric Bulletin ◽

10.1192/pb.20.1.43 ◽

1996 ◽

Vol 20 (1) ◽

pp. 43-45 ◽

Cited By ~ 5

Author(s):

Mohan Isaac

Keyword(s):

Mentally Ill ◽

Service Provision ◽

Mental Hospital ◽

Quality Of Services ◽

Paper Briefly ◽

The Past ◽

Primary Health ◽

Primary Health Centres ◽

Health Centres

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.

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Measuring Quality of Maternal and Newborn Care in Developing Countries Using Demographic and Health Surveys

PLoS ONE ◽

10.1371/journal.pone.0157110 ◽

2016 ◽

Vol 11 (6) ◽

pp. e0157110 ◽

Cited By ~ 6

Author(s):

Zoe Dettrick ◽

Hebe N. Gouda ◽

Andrew Hodge ◽

Eliana Jimenez-Soto

Keyword(s):

Developing Countries ◽

Health Surveys ◽

Newborn Care ◽

Demographic And Health Surveys ◽

Maternal And Newborn Care ◽

Maternal And Newborn

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Assessing capacity of health facilities to provide routine maternal and newborn care in low-income settings: what proportions are ready to provide good-quality care, and what proportions of women receive it?

10.21203/rs.2.19609/v1 ◽

2019 ◽

Author(s):

Keith Tomlin ◽

Della Berhanu ◽

Meenakshi Gautham ◽

Nasir Umar ◽

Joanna Schellenberg ◽

...

Keyword(s):

Low Income ◽

Quality Care ◽

Newborn Care ◽

Uttar Pradesh ◽

Routine Care ◽

Health Facilities ◽

Signal Functions ◽

Maternal And Newborn Care ◽

Maternal And Newborn

Abstract Background Good quality maternal and newborn care at primary health facilities is essential for both mothers and infants, but in settings with high maternal and newborn mortality the evidence for the protective effect of facility delivery is inconsistent. We surveyed samples of health facilities in three settings with high maternal mortality, to assess the quality of routine maternal and newborn care and the proportion of women delivering in facilities with a good standard of care. Surveys were conducted in 2012 and 2015 to assess changes in the quality of care over time. Methods Surveys were conducted in Ethiopia, the Indian state of Uttar Pradesh and Gombe State in North-Eastern Nigeria. 166 and 305 primary care facilities were sampled in 2012 and 2015 respectively. In each year we assessed whether each facility could provide four “signal” functions of routine maternal and newborn care. From facility registers we counted the number of deliveries in the previous six months and calculated the proportion of women giving birth in facilities which could offer good quality routine care. Results In Ethiopia the proportion of deliveries in facilities which provided all four signal functions rose from 40% (95% CI 26-57) in 2012 to 43% (95% CI 31-56) in 2015. In Uttar Pradesh in 2012 an estimated 4% (95% CI 1-24) of facility deliveries occurred in facilities which provided all four signal functions, rising to 39% (95% CI 25-55) in 2015. In Nigeria these estimates were 25% (95% CI 6-66) and zero for 2012 and 2015 respectively. Improvements in signal functions in Ethiopia and Uttar Pradesh were led by improved supplies of commodities while Nigeria experienced declines in supplies of commodities and the number of Skilled Birth Attendants employed. Conclusions This study quantifies how health facilities can provide sub-optimal maternal and newborn care, and may help explain inconsistent outcomes of health facility care in some settings. Signal function methodology can provide a rapid and inexpensive measure of the capacity of facilities to provide such care. Incorporating data on facility deliveries and repeating the analyses highlights the adjustments that could have greatest impact upon maternal and newborn care.

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Where there is no nurse: an observational study of large-scale mentoring of auxiliary nurses to improve quality of care during childbirth at primary health centres in India

BMJ Open ◽

10.1136/bmjopen-2018-027147 ◽

2019 ◽

Vol 9 (7) ◽

pp. e027147 ◽

Cited By ~ 5

Author(s):

Krishna D Rao ◽

Swati Srivastava ◽

Nicole Warren ◽

Kaveri Mayra ◽

Aboli Gore ◽

...

Keyword(s):

Quality Of Care ◽

Postpartum Haemorrhage ◽

Neonatal Resuscitation ◽

Staff Nurses ◽

Normal Delivery ◽

Primary Health ◽

Primary Health Centres ◽

Significant Difference ◽

Health Centres

ObjectiveClinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses.DesignQuasi-experimental post-test with matched comparison group.SettingPrimary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities.ParticipantsAnalysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison).InterventionMentoring for a duration of 6–9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care.Primary outcome measuresNurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations.ResultsMentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed.DiscussionMentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.

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