Innovations in improving maternal care through Family Planning Dr. Sunita Singal Country Clinical Advisor, Engender health

Effect of Family Planning On Maternal Death (Source Guttmacher Institute and United nation population Fund (UNFPA), 2009)

Outcome 1: Improved availability and accessibility of FP services in public health facilities (i) Establish a network of Training Centers (TC) (ii) Training of FP providers. (i) Establish a network of Training Centers (TC) (ii) Training of FP providers. Outcome 2: Improved quality of contraceptive services Quality assurance and improvement through clinical monitoring and coaching (CMC ) Outcome 3: Improved education and counseling of women on FP Quality &Informed Choice : Development of Checkpoints for choice orientation and resource package for all providers ( including 75 district health officers)

Clinical Guidelines and Standards Developing/adapting guidelines and standards Ensuring use of guidelines and standards Updating guidelines and standards Gathering/developing training materials Training providers Building training capacity Following up on training Supporting service initiation Clinical Training ENSURING CLINICAL QUALITY Collecting and using relevant data Enabling infrastructure, equipment, instruments, and supplies Ensuring informed and voluntary decision making Assessing services Clinical Monitoring and Coaching Managing emergency situations

CHECK POINTS FOR CHOICE: Innovation Client centred FP ensuring full free Informed choice. Factors that support and factors that hinder full free Informed choice. Range of challenges to full, free and Informed choice: What warrants more attention Conraceptive Method Choice: What is it & why it matters.

Preventing infections- doing it differently!! On siteWhole site Site Specific action plan On Job Training Infection prevention trainings

QI through Clinical Monitoring and Coaching Assessing services Ensuring informed and voluntary decision making Enabling infrastructure, equipment, instruments, and supplies Collecting and using relevant data Managing emergency situations

Assessing Readiness of Care What Staffing Facility, infrastructure Equipment, instruments and supplies Essential drugs and contraceptives Range of available services Functional support systems Functional referral system How Facility audit Record review Interviews with staff, managers

Assessing Processes of Care What –Clinical techniques and procedures –Clinical examinations –CPI: Ensuring informed and voluntary decision making Information giving, counseling –Infection prevention –Linkages to other services How –Observation of services and procedures –Client interviews –Staff interviews –Self, peer, and supervisor assessment

Who does assessment of services? On-site/Internal supervisors and staff Facility level Department or ward level Peers Off-site/External supervisors National/central level Regional/area level State/district level Peers (supervisors)

Collection and Use of Relevant Data Objective information on: –program activities (planning, monitoring and evaluating) –the resulting quality of services provided to clients. –Collect –Analyze –Use data. –MIS

The Data for Decision-Making Cycle Our stake- holders & Our mission Deciding what data we need Collect data Analyze data Make decisio n Imple- ment decisio n Assess implem- entation

Tools for quality measurement LIST THE TOOLS FOR MEASURING QUALITY Facility walk through Standard Observations of procedures Interviews of clients, providers and managers COPE Self assessment tools

Analysis of QA process :Measuring Quality Facility: Use Checklist and score in % using Facility checklist Supply: Use checklist of supply and score in % using supply checklist Competency: Use competency evaluation tool for each trained provider separately and mentor all. Use lowest score as indicator as % improvement. Record keeping: % of Completeness of records against expected number of records to be kept at facility Reporting: % Completeness of reporting in time

Quality Progress Evaluation indicators Percentage of project-selected facilities that provide fixed day FP services IUD, ML Number and percentage of clients who report being counseled on FP, by method Percentage facilities that report no stock out of FP commodities and equipment Percentage of facility-delivered women who received pre- discharge counseling per protocol Percentage of post FP procedural complication rates reduced Percentage of post FP procedural failures rates reduced

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