258914 Performance matters: Improving skilled birth attendants' capacity in India

Monday, October 29, 2012 : 11:00 AM - 11:15 AM

Elizabeth Fischer, MCRP , IntraHealth International, Chapel Hill, NC
Manju Shukla, MBBS, MD OBGYN , IntraHealth International, Jharkhand, India
Purpose: Jharkhand has high maternal mortality (312/100,000 live births) and low skilled attendance (28% of births in 2005/06). Since 2007, the IntraHealth International-led, USAID-funded Vistaar Project has worked with the Government of Jharkhand to increase access to skilled birth attendance in 14 districts. Vistaar has focused on scaling-up training and performance improvement best practices within the skilled birth attendant (SBA) program.

Data/information used: To date, over 1,338 auxiliary nurse-midwives (ANMs) have been trained in these 14 districts and 200 medical officers trained in supportive supervision.

Methods used: The program applied a performance improvement approach, addressing recognized performance factors related to knowledge/skills, job expectations, performance feedback, physical environment, and motivation. Vistaar supported the government to 1) improve SBA training methods to ensure competency-based training; 2) promote medical officers' regular supportive supervision of ANMs, with on-the-job support; and 3) establish a recognition program to acknowledge ANMs' contributions to quality care.

Results: Over a three-year period, trained SBAs reported an increase from 58% to 89% in partograph use in at least 75% of deliveries attended during the previous month. They reported an increase in the practice of active management of third stage of labor from 0% to 98%. SBAs increased practices of newborns being dried and wrapped (52% at baseline to 88% in Oct-Dec 2011) and breastfed within one hour of delivery (1% at baseline to 38%).

Recommendations: This program offers lessons applicable to other contexts for enabling SBAs to practice evidence-based approaches to provide quality services for maternal and newborn care.

Learning Areas:
Administer health education strategies, interventions and programs
Provision of health care to the public
Public health or related education
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Explain how performance improvement approach was used to improve skilled birth attendance 2. Describe the outcomes achieved from strengthening government processes 3. Identify lessons learned and implications for other contexts

Keywords: Maternal and Child Health, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been involved in providing technical support to the project since its inception. Thus support has included contributing to the technical design, documenting processes, conducting a cost analysis of the program, analyzing baseline and endline data on intervention results and periodic site visits to program intervention areas.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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