ISQUA18-2325Designing and Implementing Competency Based Certification Program to Improve Quality of Intra and Immediate Postpartum Care in Private Sector – Experience from India

Abstract

Objectives: Reduction of maternal and early neonatal mortality remains an unfinished agenda. In India, the private sector is largely unorganized and contributes to approximately 26% institutional deliveries. Various studies demonstrate that quality of care in private sector maternity care centers remains uncertain. Public health facilities in India have begun focusing on improving the quality of maternity care through the implementation of Dakshata program but the private sector has not received similar focus. Jhpiego in partnership with Federation of Obstetric and Gynecological Societies of India (FOGSI) and with support from MSD for Mothers, has designed and implemented a competency-based quality improvement and certification program called “Manyata” (which means 'Recognition') to improve and sustain the quality of maternity care in Uttar Pradesh, Jharkhand and Maharashtra. This paper aims to disseminate the experiences of program implementation and initial outcomes. Methods: The Manyata program is based on the 16 FOGSIendorsed key maternity care standards which consist of 56 objective elements and 111 verification criteria. External assessment of the private healthcare facility is conducted by a FOGSI nominated assessor and when the facility demonstrates adherence to prescribed standards, Manyata certification is granted by FOGSI which is valid for 2 years, subject to adherence to surveillance norms. Jhpiego in partnership with FOGSI is implementing this program in more than 150 facilities across three states in India, conducting training for service providers and mentoring the facility staff for a period of 6-8 months. FOGSI assessed these facilities once the quality improvement cycle was completed and the external assessments' findings were compiled and analyzed. Results: A total of 168 facilities were identified through large-scale sensitization meetings about the Manyata program and referrals. Baseline assessments using standards were conducted and the average score came out to be 43%. This was followed by 27 batches of skill-based training in which 851 participants were trained. After the training was completed, each facility received a minimum of 6 structured mentoring visits to facilitate adherence to standards. A total of 577 mentoring visits were conducted. External assessments were conducted by FOGSI assessors at 125 facilities using the clinical standards, out of which 122 facilities achieved the desired 85% score and qualified to receive Manyata Certification. Conclusion: It can be concluded that through programmatic support, professional and technical bodies like FOGSI can develop an effective skill-based certification program to improve and ensure the quality of care in the private sector. This type of certification program can also complement existing accreditation programs as an additional tool for skill assessment.