Scaling up a quality improvement initiative under the Government of India’s RMNCH+A program: Lessons from Chamba District
From December 2013, ASSIST’s India team started providing support for quality improvement (QI) initiatives to improve services at health facilities in Chamba District in Himachal Pradesh State. Within a few months, the district government saw good, sustained results from QI initiatives for the Government of India’s RMNCH+A program and with ASSIST’s support, the district government has been very active at all levels (facility, district, state) in scaling up QI.
ASSIST documented its efforts Chamba through a video that highlighted how QI approaches can be used to provide better care in challenging areas of India and how governments can adopt these approaches using their own resources.
Chamba’s difficult terrain in both rural and urban areas may impact the quality of services at facilities but also care-seeking behaviors in vulnerable populations such as pregnant women. However, QI teams have been able to manage problems at the local level and provide better care in all selected health facilities. The usual approach of training providers and sensitizing them to guidelines and standards will always work to improve health care but introducing the QI methodology has helped these providers to problem solve issues at their facility in a systematic way.
Lack of infrastructure and human resources have proven to not be constraints for QI teams in Chamba to improve care. In using the seven steps of quality improvement, they have demonstrated that improvement can be achieved without putting in extra resources for such issues as managing high risk pregnancies and reducing neonatal referrals due to birth asphyxia. Facilities have also improved their data recording and using that data to make better decisions along with ensuring early registration of antenatal care for pregnant women.
The results sustained in Chamba through QI initiatives have motivated front line health workers, block & district level managers and top level policy makers to look beyond the traditional approach of monitoring, training, adhering to guidelines or focusing on inputs only. Quick and good results encourages the staff to doing better and better.