PHC Childbirth and Neonatal Care
Improving quality of child birth and neonatal care in primary health centres in two districts in Haryana, India
The project was started in September, 2013 with the aim to improve quality of child birth and neonatal care in selected Primary Health Centres of Haryana. It was a collaborative effort between National Rural Health Mission, Haryana, SWACH Foundation, Government Medical College and Hospital, Chandigarh and All Institute of Medical Sciences, New Delhi, India. The project was funded by WHO and happened from 01-09-2013 to 31-10-2015.
The baseline observations were started in all the 15 PHCs of Haryana from 3 February 2014. By a process of randomization undertaken in WHO HQs, 3 PHCs (Majri, Khizrabad and Panjokhra) were selected and quality improvement interventions were started from May 2014. In the first week of May, the 3 PHCs were visited for orienting the staff regarding key interventions that would bring about improvement in child birth and post natal care practices. A 3 days training was then organized in Panchkula (11-14 May 2014) in which all the concerned staff participated. The meeting was facilitated by NRHM, SWACH and Ernest and Young representing AIIMS staff. Detailed discussion was done on key issues. Gaps were identified and plan was prepared for achieving the common goal of improving the quality of services related to childbirth and newborn care at the 3 PHCs. The participants were briefed about quality improvement processes, SOPs, audit tools, audit processes and the plans for implementation. The process of audit of death and adverse outcome was also explained. It was agreed that quality improvement process would include Internal Quality Assessment in the form of weekly and monthly review meetings and External Quality Assessment to be quarterly by an external team. Another lot of 3 PHCs were selected through the process of randomization by W.H.O. – HQ for intervention w.e.f. 01-08-2014. These included Chhachhrauli, Haibatpur and Burhia. PHCs under intervention and non-intervention are given in the illustration below:
Followup IMCI
Background
In India, Acute Respiratory Infections especially pneumonia, diarrhoea and under nutrition account for a large number of deaths in children below five years of age. These deaths are preventable, if treated timely and correctly. Since the BHWs are responsible for providing health care to the children in the community and they are the first to be contacted when children are sick. The BHW training course on Integrated Management of Childhood Illness (IMCI) is designed to help them acquire technical as well as communication skills to manage sick children in an integrated and effective manner. In the order to reduce the morbidity and mortality among children in the age group of 2 months- 5 years, the Anganwari Workers were trained on IMCI course which included assessment of the child, classification of diseases, identifying treatment, providing treatment, counseling mothers about homecare, feeding of the child and follow-up. Whenever a new skill is imparted to any person, it is accepted better if it is backed by follow-up visits to reinforce learning. This gives added confidence to the individual and motivates them to incorporate IMCI in practice. That is why the 288 Anganwari workers trained earlier on IMCI were followed up by the supervisors who were trained both on 5 days IMCI course as well as 3 days training on follow-up visits after training.
Objectives
To train supervisors as well as the BHWs on technical skills of:
- Early referral of seriously ill children in the age group of 2 months-5 years.
- Treating children with dehydration by ORS.
- Treating children with pneumonia by co-trimoxazole.
- Advising mother on feeding
- Giving fluids
- Relieving cough by homemade cough remedies.
- Observing the child for selected signs for follow-up.
- Plan and prepare for follow-up visits.
- Conduct follow-up visits using various protocols like review of records, case observation to see the skill of the BHW, review of facility support, etc.
To train them on communication skill of:
To make supervisors able to:
PVI Toolkit
Background
The Parent Voices Initiative (PVI) was developed by the Stillbirth Advocacy Working Group (SAWG) which is co-chaired by the International Stillbirth Alliance (ISA) and the London School of Hygiene & Tropical Medicine (LSHTM). This is funded by the Partnership for Maternal, New-born and Child Health. The purpose of the PVI is to raise the voice and participation of parents bereaved by stillbirth to strengthen advocacy for stillbirth prevention and post-stillbirth bereavement support. The India Providers Toolkit pilot project focused on improving communication between parents and health providers with the ultimate aim of fostering an environment conducive to stillbirth parents being able to advocate on their own behalf for bereavement support and stillbirth prevention. It focuses on health providers working within health facilities and communities, to provide them with information and suggested approaches for deeper and more open communication with parents after a stillbirth.
This toolkit covers breaking bad news, talking with parents about how and why their baby may have died, acknowledging their grief, making room for them to express their need for support, providing respectful bereavement care, facilitating dedicated space away from birthing women and new-borns, and discussing a safe plan for future pregnancies. The India Providers Toolkit was developed in consultation with health providers which was again revised to incorporate parent’s perspective after consultation with the parents.
Phase II of the Above mentioned project continued Under Title “To adapt the stillbirth Advocacy toolkit developed for health providers in India (the Indian provider’s toolkit) under the parent voices initiative to incorporate the perspective of Indian parents bereaved by stillbirth and their expectations from the health providers, laying the groundwork for toolkit implementation and scale-up in India and adaption to other SEARO countries. Investigators and Collaborators were from PGIMER, Chandigarh, India, Public Health Foundation of India, Gurugram, India, SWACH Foundation Panchkula India, LSHTM UK, Chair ISA, Advisor ISA
International Stillbirth Alliance’s Raising Parent Voices Advocacy Toolkit for Health Providers in India was revised in two workshops conducted in Phase I of the “Raising Parent Voices advocacy toolkit”. As per recommendations from the participants the toolkit was intended to be revised according to Indian context based on the parent’s feedback. The Toolkits revision based on parents input in India was funded By WHO SEARO to achieve the following objectives.
Objective:
- Translation of the toolkit in to Vernacular Language.
- Consultation with parents in series of key informant interviews and focus group Discussion;
- Adapt the toolkit to reflect the consultation