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Monday, January 22, 2018

Integrate Learnings To Succeed

Wednesday, 01 November 2017 13:21
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Leila Caleb Varkey


Combining best practices from various States can result in a significant and rapid reduction of maternal and newborn deaths

Recently, there has been shift in the focus of reproductive and maternal health care from improving coverage towards improved quality of care. However, there still remain vast differences in Maternal Mortality Ratio (MMR) and Neonatal Mortality Rate (NMR) across States despite the multiple efforts towards improving quality of care services for pregnant women, mothers and newborns in India. Finding those procedures and practices which have helped some States achieve good results and integrating this evidence-based impactful solution into another State's public health system by adapting and replicating it for proper execution can result in rapid reduction of needless maternal and newborn deaths in the country.

The quality of care reproductive health services, which women receive in each State, rest primarily on how each State allocates and utilises its funds, manages its human resources, develops and maintains its infrastructure. The good practices in the originating State, if documented and adopted as a model in another State, would be most useful in upgrading the adopting State's health system. Adopting the quality of care models will lead to improved status of maternal health by maximising benefits of already existing mechanisms and addressing gaps and bottlenecks in maternal health services.

Examples of some of the good practices adopted by some States given below show how innovations and models have led to quality improvement. These good practices have not yet been adopted by other States. With little adaptation, these could rapidly bring gains in quality of care if adopted and executed by different States across institutions. Tracing back to Rajasthan's model for HR e-payment to community health workers, ASHA-Soft - a well-tested and successful technology - can be implemented in other parts of the country too. The initiative was taken up by the Rajasthan State Health Mission in collaboration with National Informatics Centre, Rajasthan State Unit. Since ASHA workers form a large group of HR for maternal welfare, their work satisfaction matters.

ASHA-Soft was launched with the key objective of ensuring timely and transparent online-payment to ASHAs and improving their monitoring system. It is linked with Maternal Child Tracking System (MCTS) and strengthens the MIS by increased entry of beneficiaries in 'Pregnancy, child tracking and Health Services Management System (PCTS)' and the 'Maternal Child Tracking System (MCTS)' as both the data are interlinked for better payment verification. While the software has been implemented in Rajasthan only, this technology has the potential to improve maternal healthcare in rural India through its indirect approach model. 

Chhattisgarh has worked towards building better reports on satisfaction with HR and infrastructure by expectant and new mothers through a Patient Feedback Mechanism at the district level. The patient satisfaction survey used with inpatients gathered women's feedback, analysing the findings and taking necessary actions to address the issues raised by the patients and their kin, visiting the hospital. This PFM aims to assess the satisfaction with delivery services; identifies requirements of patients and service providers and analyses the findings to take actions to address the concerns. The overall patient satisfaction score improved from 2.4 to 3.9 over a period of 5 years and there is improved utilisation rate of OPD and IPD.

E-Upchaar is one of the e-governance initiatives being implemented by the Haryana State Health Systems Resource Centre (HSRC) to improve quality of service delivery. The initiative has brought administrative efficiency through ICT enabled Hospital Information System. It has streamlined and digitised workflows. E-Upchaar encompasses complete solutions on health management information system (HMIS), core application, electronic health record (EHR), HMIS back-end support, Medical information system reports, Government of India and Haryana Government's applications, and a web portal. The Government of Haryana (GoH) approved E-Upchaar as a financially viable system and has received immense support from policy makers and political leaders in Haryana.

Since 2012, Kerala Government has been implementing a comprehensive, less expensive and easy mechanism to accredit its hospitals called Kerala Accreditation Standards for Hospitals (KASH), compared to those provided by other accreditation standards such as National Accreditation Board for Hospitals (NABH) and Health care organisation, and National Standards on Quality Assurance (NSQA). These standards have raised the quality of healthcare services provided by public hospitals in Kerala and match standards in the best of the Government hospitals in the country.

Participatory Audit and Planning (PAP) for community-oriented utilisation of RKS funds implemented in Maharashtra, takes the essence of social audit and strengths Community Based Monitoring and Planning of RKS funds with a digital structure. PAP ensures effective, planning and utilisation of RKS funds and helps to improve efficiency in transfer and utilisation of funds from District to the facility. Based on the positive experience of PAP in a pilot area, Maharashtra's State Health Mission has decided to implement the PAP process in all Community Based Monitoring and Planning (CBMP) blocks. The State Health Resource Centre and RKS cell at State NHM office is playing an important role in expanding and facilitating the PAP process in the entire State. If PAP process is aligned with Government 'Digital India' mission, it can be adapted in other States too for streamlining the process of planning and disbursing of RKS funds work through digitisation.

The above are just few of the examples of the good practices which stand out as benchmarks of innovation in practices as they have consistently shown better results compared to those achieved by other means.

 (The writer is a freelance contributor) 

(Courtesy: Pioneer)


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