ISQUA17-3126MEASURING AND IMPROVING THE QUALITY OF PRIVATE MATERNITY CARE: LESSONS LEARNED FROM A PRIVATE SECTOR QI PROGRAM IN INDIA

Abstract

Objectives: Quality improvement (QI) for childbirth care is a priority for India. Private sector contributes to up to 47% and 24% of care during institutional births in urban and rural areas respectively in the country. Focus on QI for childbirth care among private maternity providers, is limited due to the private sector's unorganized and unregulated structure, perceived lack of motivation for measuring quality, and non-availability of practical, standardized measurement tools. With support from MSD for Mothers, Jhpiego partnered with the Federation of Obstetrics and Gynaecological Societies of India (FOGSI) to improve private maternity providers' engagement in quality improvement program. This paper presents key results and lessons learned on engaging and sustaining private sector's focus on quality improvement for maternity services. Method(s): We implemented a streamlined, quality measurement and improvement approach based on a prioritized set of standards of care focused on intrapartum and immediate postpartum period. To address gaps identified through assessments, focused action plans including short training, in-facility mentoring, advocacy for prioritizing resources, and improve data recording and reporting were developed and implemented. To improve motivation for measuring and improving quality of care, the program included peer assessments and recognition via a FOGSI quality seal. Jhpiego implemented this program in 140 private facilities ranging from single obstetrician-led practice to corporate hospitals in the Indian states of Uttar Pradesh and Jharkhand between year 2012 and 2015. Result(s): The program successfully engaged 146 out of 200 total eligible facilities (72%) in the target cities for the entire duration. Of these, only six (4.1%) dropped out. All remaining (140) facilities completed five rounds of quality assessments over two years. 94% partnering facilities standardized data recording for childbirth care practices by means of a birthing register and 96% shared data on quality. Compliance to standards of care improved across the board. Out of total 146 facilities, at baseline, only 3% of participating providers demonstrated >70% rate of compliance with the standards of care. After two years of implementation, 84.5% of providers (82% in Jharkhand and 87% in Uttar Pradesh) met >70% of the standards. Overall compliance to the standards improved from 42% at the baseline to 78% in the latest assessments. The greatest improvements were made between the baseline and first assessments. On average, facility scores on performance standards jumped by 38% in that time. Additional improvements occurred more gradually, with scores improving an additional 12% on average by the second assessment, another 9% on average by the third assessment, and another 9% on average by the fourth assessment. Conclusion(s): FOGSI played an important role in engaging and motivating private providers to measure quality. Engaging providers in adapting tools and measurement processes to suit their needs improved ownership of the process. Peer assessment and linked, public recognition are important motivators to sustain quality measurement and improvement for private maternity providers. Another key takeaway was that the private sector is willing to sustainably engage with quality improvement initiatives and is open to sharing data on content of care contrary to the current understanding of private sector's motivation in India.