Performance matters: Improving skilled birth attendants' capacity in 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.