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Nair TS, Memon P, Tripathi S, Srivastava A, Sunny Kujur M, Singh D, Bhamare P, Yadav V, Kumar Srivastava V, Prasad Pallipamula S, Usmanova G, Kumar S. Implementing a quality improvement initiative for private healthcare facilities to achieve accreditation: experience from India. BMC Health Serv Res 2023; 23:802. [PMID: 37501069 PMCID: PMC10375635 DOI: 10.1186/s12913-023-09619-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/30/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The Manyata program is a quality improvement initiative for private healthcare facilities in India which provided maternity care services. Under this initiative, technical assistance was provided to selected facilities in the states of Uttar Pradesh, Jharkhand and Maharashtra which were interested in obtaining 'entry level certification' under the National Accreditation Board for Hospitals and Healthcare Providers (NABH) for provision of quality services. This paper describes the change in quality at those Manyata-supported facilities when assessed by the NABH standards of care. METHODS Twenty-eight private-sector facilities underwent NABH assessments in the three states from August 2017 to February 2019. Baseline assessment (by program staff) and NABH assessment (by NABH assessors) findings were compared to assess the change in quality of care as per NABH standards of care. The reported performance gaps from NABH assessments were then also classified by thematic areas and suggested corrective actions based on program implementation experience. RESULTS The overall adherence to NABH standards of care improved from 9% in the baseline assessment to 80% in the NABH assessment. A total of 831 performance gaps were identified by the NABH assessments, of which documentation issues accounted for a majority (70%), followed by training (19%). Most performance gaps could be corrected either by revising existing documentation or creating new documentation (62%), or by orienting facility staff on various protocols (35%). CONCLUSION While the adherence of facilities to the NABH standards of care improved considerably, certain performance gaps remained, which were primarily related to documentation of facility policies and protocols and training of staff, and required corrective actions for the facilities to achieve NABH entry level certification.
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Affiliation(s)
- Tapas Sadasivan Nair
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Parvez Memon
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Sanjay Tripathi
- Jhpiego - an affiliate of Johns Hopkins University, Lucknow, Uttar Pradesh, India
| | - Ashish Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Meshach Sunny Kujur
- Jhpiego - an affiliate of Johns Hopkins University, Ranchi, Jharkhand, India
| | - Deepti Singh
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Parag Bhamare
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Vikas Yadav
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Vineet Kumar Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Suranjeen Prasad Pallipamula
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
| | - Gulnoza Usmanova
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India.
| | - Somesh Kumar
- Jhpiego - an affiliate of Johns Hopkins University, Prius Platinum, A Wing, 5th Floor, D3, P3B, Saket District Centre, Sector 6, Saket, New Delhi, Delhi, 110017, India
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Delaney MM, Usmanova G, Nair TS, Neergheen VL, Miller K, Fishman E, Bajpai N, Memon P, Bobanski L, Singh D, Srivastava VK, Divakar H, Pai H, Semrau KEA, Pallipamula SP. Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector. Glob Health Sci Pract 2022; 10:GHSP-D-22-00093. [PMID: 36562433 PMCID: PMC9771457 DOI: 10.9745/ghsp-d-22-00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. METHODS We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. RESULTS From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. CONCLUSION Our analysis indicates private facilities' adherence to quality standards and nurses' childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.
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Affiliation(s)
- Megan Marx Delaney
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Correspondence to Megan Marx Delaney ()
| | | | | | - Vanessa L. Neergheen
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Kate Miller
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Eliza Fishman
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Lauren Bobanski
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Hema Divakar
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Hrishikesh Pai
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Katherine E. A. Semrau
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital; Department of Medicine, Harvard Medical School; Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
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Kumar S, Usmanova G, Nair TS, Srivastava VK, Singh R, Mohanty N, Akhtar N, Kujur MS, Srivastava AK, Pallipamula SP, Agarwal G, Singh AB, Kashyap V, McCarthy M, Liebermann EJ, Ginsburg O. Implementation of a large-scale breast cancer early detection program in a resource-constrained setting: real-world experiences from 2 large states in India. Cancer 2022; 128:1757-1766. [PMID: 35133005 PMCID: PMC9303860 DOI: 10.1002/cncr.34114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 12/19/2022]
Abstract
Background The Breast Health Initiative (BHI) was launched to demonstrate a scalable model to improve access to early diagnosis and treatment of breast cancer. Methods A package of evidence‐based interventions was codesigned and implemented with the stakeholders, as part of the national noncommunicable disease program, through the existing primary health care system. Data from the first 18 months of the BHI are presented. Results A total of 108,112 women received breast health education; 48% visited the health facilities for clinical breast examination (CBE), 3% had a positive CBE result, and 41% were referred to a diagnostic facility. The concordance of CBE findings between health care providers and adherence to follow‐up care improved considerably, with more women visiting the diagnostic facilities and completing diagnostic evaluation within 1 month from initial screening, and with only 9% lost to follow‐up. The authors observed a clinically meaningful decrease in time to complete diagnostic evaluation with biopsy, from 37 to 9 days. Conclusions The results demonstrate the feasibility and effectiveness of implementing a large‐scale, decentralized breast cancer early detection program delivered through the existing primary health care system in India. This article presents the key strategies, interventions, and results from the first 18 months of the large‐scale, decentralized breast cancer early detection program in a real‐world setting in India.
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Affiliation(s)
- Somesh Kumar
- Jhpiego, New Delhi, India.,Technical Leadership & Innovations, Jhpiego, Baltimore, Maryland
| | | | | | | | - Rakesh Singh
- Monitoring, Evaluation and Research, Jhpiego, Lucknow, India
| | | | - Nadeem Akhtar
- Noncommunicable Diseases Unit, National Health Mission, Lucknow, India
| | | | | | | | - Gaurav Agarwal
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Vivek Kashyap
- Rajendra Institute of Medical Sciences, Ranchi, India
| | - Maura McCarthy
- Corporate and Foundation Partnerships, Jhpiego, Baltimore, Maryland
| | - Erica J Liebermann
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Ophira Ginsburg
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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Ricca J, Dwivedi V, Varallo J, Singh G, Pallipamula SP, Amade N, de Luz Vaz M, Bishanga D, Plotkin M, Al-Makaleh B, Suhowatsky S, Smith JM. Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries. BMC Health Serv Res 2015; 15:9. [PMID: 25609355 PMCID: PMC4307135 DOI: 10.1186/s12913-014-0667-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 12/16/2014] [Indexed: 12/05/2022] Open
Abstract
Background Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in developing countries. While incidence of PPH can be dramatically reduced by uterotonic use immediately following birth (UUIFB) in both community and facility settings, national coverage estimates are rare. Most national health systems have no indicator to track this, and community-based measurements are even more scarce. To fill this information gap, a methodology for estimating national coverage for UUIFB was developed and piloted in four settings. Methods The rapid estimation methodology consisted of convening a group of national technical experts and using the Delphi method to come to consensus on key data elements that were applied to a simple algorithm, generating a non-precise national estimate of coverage of UUIFB. Data elements needed for the calculation were the distribution of births by location and estimates of UUIFB in each of those settings, adjusted to take account of stockout rates and potency of uterotonics. This exercise was conducted in 2013 in Mozambique, Tanzania, the state of Jharkhand in India, and Yemen. Results Available data showed that deliveries in public health facilities account for approximately half of births in Mozambique and Tanzania, 16% in Jharkhand and 24% of births in Yemen. Significant proportions of births occur in private facilities in Jharkhand and faith-based facilities in Tanzania. Estimated uterotonic use for facility births ranged from 70 to 100%. Uterotonics are not used routinely for PPH prevention at home births in any of the settings. National UUIFB coverage estimates of all births were 43% in Mozambique, 40% in Tanzania, 44% in Jharkhand, and 14% in Yemen. Conclusion This methodology for estimating coverage of UUIFB was found to be feasible and acceptable. While the exercise produces imprecise estimates whose validity cannot be assessed objectively in the absence of a gold standard estimate, stakeholders felt they were accurate enough to be actionable. The exercise highlighted information and practice gaps and promoted discussion on ways to improve UUIFB measurement and coverage, particularly of home births. Further follow up is needed to verify actions taken. The methodology produces useful data to help accelerate efforts to reduce maternal mortality.
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Affiliation(s)
- Jim Ricca
- Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
| | - Vikas Dwivedi
- Maternal and Child Survival Program, JSI Research & Training Institute, Inc, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
| | - John Varallo
- Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
| | - Gajendra Singh
- Jhpiego, 221, Okhla Phase III, New Delhi, 110 020, India.
| | - Suranjeen Prasad Pallipamula
- Maternal Child Integrated Program (MCHIP), Jhpiego, Government Vaccine Institute Campus, Namkum, Ranchi, Jharkhand, 834010, India.
| | - Nazir Amade
- Director of Maternal and Child Health, Ministry of Health, Maputo, Mozambique.
| | | | | | - Marya Plotkin
- Jhpiego Tanzania, PO Box 9170, Dar es Salaam, Tanzania.
| | | | - Stephanie Suhowatsky
- Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
| | - Jeffrey Michael Smith
- Maternal and Child Survival Program, Jhpiego, 1776 Massachusetts Ave., NW #300, Washington, DC, 20036, USA.
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