Online Program

Engaging providers in setting and using standards: Towards improving performance of postpartum intra-uterine contraceptive device (PPIUCD) services in India

Monday, November 4, 2013 : 4:30 p.m. - 4:45 p.m.

Saswati Das, Clinical Services and Training, Jhpiego, India, New Delhi, India
Bulbul Sood, Jhpiego, India
Somesh Kumar, Jhpiego, India
Rashmi Asif, Jhpiego, India
Vikas Yadav, Jhpiego, India
Naresh Joshi, Jhpiego, India
Background: Given high unmet need for postpartum family planning and increasing institutional deliveries, government initiated strengthening PPIUCD services in selected hospitals (46) of 19 states, with Jhpiego's technical assistance. Method: Performance standards, verification criteria were set jointly by representative-providers from 19 states. With Jhpiego's post-training support, providers implemented services, assessed performance, analysed root cause of gaps and implemented action plans. Results of performance assessments of PPIUCD facilities conducted 4-6 months apart and service statistics are used here. Results: 46 facilities inserted over 81000 PPIUCD during 2010-12. Overall performance scores on standards improved from 39% during baseline to 82% during the end-line assessment. The performance scores for quality of counselling during ANC and early labour improved from 34 % and 44% respectively to 87% and 92%. Similarly, performance scores for quality of PPIUCD service delivery improved from 35% to 79% and record keeping from 50% to 73%. Percentage of facilities scoring >80% for overall quality standards increased from 3% to 73% during project period (2010-12). Follow-up of 30328 PPIUCD clients after 6 weeks of insertion revealed 2.36 % expulsions, 0.88% infections, 4.06% removal, 5.29% other complaints and 87% without any complaint, and thus justified performance improvement efforts. Recommendation: Involvement of providers in setting and using standards can result in substantial improvement in performance of PPIUCD services.

Learning Areas:

Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Identify that involving providers in setting and using standards is an effective approach for performance improvement of postpartum IUCD (PPIUCD) services in public sector health facilities.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am working as Senior Advisor: Clinical Services and Training in Jhpiego India focusing on providing technical assistance, which is funded by the Bill and Melinda Gates Foundation, to Government of India's program on scaling Up of postpartum family planning and postpartum IUCD services in India.
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.