Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India

Taneja, Gunjan; Sarin, Enisha; Bajpayee, Devina; Chaudhuri, Saumyadripta; Verma, Geeta; Parashar, Rakesh; Chaudhry, Nidhi; Mohanty, Jaya Swarup; Bisht, Nitin; Gupta, Anil K.; Tomar, Shailendra Singh; Patel, Ratna; Sridhar, V.S.; Joshi, Anurag; Rathi, Chitra; Baswal, Dinesh; Gupta, Sachin; Gera, Rajeev

doi:10.9745/ghsp-d-20-00368

Cited by 5 publications

(12 citation statements)

References 26 publications

(40 reference statements)

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“…This might be because training provided to obstetrics care providers related to basic emergency obstetrics and newborn care may enhance basic knowledge and skills about PNC in the management of complications that arise during the postnatal period, especially during the first 24 hours. This was supported by findings from previous studies revealed that training health professionals improve their adherence to available evidence or guidelines,27 and implementation framework combining training, mentoring, demonstrating and redemonstrating of the healthcare providers in the maternity ward on immediate PNC improves the performance of healthcare providers from preprograms to postprogrammes 12 28 29. Interactive and targeted education may be effective in developing clinical practitioner knowledge, skills and attitudes about a guideline’s recommendations 23 30…”

Section: Discussionmentioning

confidence: 56%

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

Bune,

Girmaye,

Lemma

et al. 2023

BMJ Open

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ObjectivesImmediate postnatal care is a critical intervention to reduce maternal and neonatal morbidity and mortality; however, many women and newborns receive inadequate postnatal care timely and effectively during the first 24 hours following childbirth. Therefore, this study aimed to assess the immediate postnatal care guidelines implementation and its associated factors among healthcare providers in the East Shewa zone public health facilities, Oromia, Ethiopia.DesignFacility-based cross-sectional study was conducted from 13 September 2022 to 28 October 2022.SettingThe study was conducted in 6 hospitals and 19 health centres in the East Shewa zone.ParticipantsAll healthcare providers who work in the maternity ward of the East Shewa zone public health facilities were the source population while all healthcare providers who work in the maternity ward of the randomly selected East Shewa zone public health facilities were the study population. Healthcare providers who were assigned to the delivery and postnatal ward during data collection were included in the study. Healthcare providers, who are not on duty for annual, maternity, sick and study leave, were excluded from the study.MeasuresA structured self-administered questionnaire and observational checklist were used for data collection. The questionnaires were pretested and data were collected by the Kobo toolbox software. Data were analysed by using the SPSS V.25. Binary logistic regression (bivariate and multivariable) analyses were done to identify significantly associated variables, and finally, an adjusted OR (AOR) at a 95% CI was used to declare significant variables depending on a p<0.05.ResultThe study revealed that 196 healthcare providers with a response rate of 97.03% were included in this study. The overall proportion of healthcare providers who have a good implementation of immediate postnatal care guidelines was 44.4% (95% CI 37.3% to 51.6%). Providers who received basic emergency obstetrics and newborn care training (AOR 3.72, 95% CI 1.7 to 8.1), working in a tertiary-level hospital (AOR 3.85, 95% CI 1.3 to 11.2), and who had maternal and newborn care guidelines in their facility (AOR 3.2, 95% CI 1.5 to 6.6) were significantly associated factors with good implementation of immediate postnatal care guidelines.ConclusionsImplementation of the immediate postnatal care guideline by healthcare providers in the maternity ward was found low as less than half of healthcare providers have good implementation. Receiving basic emergency obstetrics and newborn care training, having maternal and newborn care guidelines in their facility, and working in a tertiary-level hospital were significantly associated factors with good implementation of immediate postnatal care guidelines.

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Section: Discussionmentioning

confidence: 56%

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

Bune,

Girmaye,

Lemma

et al. 2023

BMJ Open

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“… 29 30 For example, an improvement intervention in India that used an integrated training, mentoring and a Plan-Do-Study-Act cycle with an emphasis on peer learning improved postpartum monitoring of mothers from 52% to 94%. 31 However, this study also shows the limits of micro-focused interventions. The potential for a 2% point improvement from pairing providers will not overcome the enormous quality deficit seen in labour and delivery care in Dire Dawa.…”

Section: Discussionmentioning

confidence: 65%

“…Interventions that aim to change facility norms on quality of care, such as group problem solving or quality improvement collaboratives have shown moderate to high effects on health worker practices in meta-analyses 29 30. For example, an improvement intervention in India that used an integrated training, mentoring and a Plan-Do-Study-Act cycle with an emphasis on peer learning improved postpartum monitoring of mothers from 52% to 94% 31. However, this study also shows the limits of micro-focused interventions.…”

Section: Discussionmentioning

confidence: 99%

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

Gage

Yakob²,

McConnell³

et al. 2022

BMJ Open

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ObjectivesTo examine how characteristics of clinical colleagues influence quality of care.DesignWe conducted a cross-sectional observational study examining the associations between quality of care and a provider’s coworkers, controlling for individual provider’s characteristics and contextual factors.SettingNine health facilities in Dire Dawa Administration, Ethiopia, from December 2020 to February 2021.Participants824 clients and 95 unique providers were observed across the 9 health facilities.Outcome measuresWe examine the quality of processes of intrapartum and immediate postpartum care during five phases of the delivery (first examination, first stage of labour, third stage of labour, immediate newborn care and immediate maternal postpartum care).ResultsFor the average client, 50% of the recommended routine clinical actions were completed during the delivery overall, with immediate maternal postpartum care being the least well performed (17% of recommended actions). Multiple healthcare providers were involved in 55% of deliveries. The number of providers contributing to a delivery was unassociated with the quality of care, but a one standard deviation increase in the coworker’s performance was associated with a 2% point increase in quality of care (p<0.01); this association was largest among providers in the middle quartiles of performance.ConclusionsA provider’s typical performance had a modest positive association with quality of delivery care given by their coworker. As delivery care is often provided by multiple healthcare providers, examining the dynamics of how they influence one another can provide important insights for quality improvement.

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“…-A number of interventions were combined with this intervention. 23 G. Taneja, et al India, 2021 [ 44 ] -A baseline assessment was done using a structured checklist -This was compared with an external endline assessment Intervention evaluation No No: Not ICM standard Yes Yes Observed improved quality -An integrated approach was effective in reducing maternal and newborn mortality. -The approach demonstrated a successful operational design for improving the delivery of intrapartum and immediate postpartum care.…”

Section: Resultsmentioning

confidence: 99%

“…Of the articles that addressed mentoring (including mentoring of midwives), thirty evaluated mentoring interventions and five were literature reviews. Most mentors were project-based, providing support to government health facilities; some were government employees [ 23 , 36 , 40 , 44 , 45 , 61 , 62 ]. Except for one project that used international mentors, all mentors were national nurses, midwives, or doctors and all mentorship was conducted onsite [ 64 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review

Anderson,

Zaman,

Jimmy

et al. 2023

BMC Pregnancy Childbirth

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Background There is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems. Methods An integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis. Results Fifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers. Conclusions Effectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization. Trial registration The protocol is registered in PROSPERO (CRD42022367657).

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Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India

Cited by 5 publications

References 26 publications

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

Immediate postnatal care guidelines implementation and associated factors among healthcare providers in East Shewa zone public health facilities, Oromia, Ethiopia, 2022: a multicentre cross-sectional study

The role of teams in shaping quality of obstetrical care: a cross-sectional study in Dire Dawa, Ethiopia

Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review

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