Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons

Abstract

BackgroundInadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020.MethodsA total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the ‘translating research in practice’ framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites.ResultsThree implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region.ConclusionThe development of an implementation framework for POCQI is an essential requirement for the initiative’s successful country-wide scale. The implementation plan should be flexible to the healthcare system’s needs, target population and the implementing agency’s capacity and amenable to multiple iterative changes.

Impact of Point of Care Quality Improvement Training and Coaching on Quality Perceptions of Health Care Workers: Implication for Quality Policy

“… 39 Moreover, the strategy of POCQI implementation also successfully in improving quality of care in 131 facilities in India. 40 PHCs and hospitals in the district have limited resources. PHC and public hospitals are under the responsibility of the DHO in the local health system.…”

“…POCQI implementation encourages community decision making, health workers and national health system policies. 40 …”

“…POCQI implementation encourages community decision making, health workers and national health system policies. 40 The quality policy in health care facilities should be managed by the state so that improving the quality of services in the forefront units can be implemented in all HCFs. Some countries that already have national institutions to enhance the quality of health services generally have better outcomes.…”

A Point of Care Quality Improvement Initiative for Enhancing Immediate Drying of Babies and Prevention of Hypothermia in Labor Room, Nishtar Medical University, Multan Pakistan

“…A recent regional study by Patodia J et al showed that implementation of WHO POCQI resulted in overall reduction of hyperthermia from 82% to 45%. 12 POQCI is cost effective approach that can reduce neonatal intensive care unit (NICU) admissions while in a developing country like Pakistan with resource limitations, prevention of hypothermia can potentially reduce overall burden of morbidity and mortality. 19,20 Our study had some limitations as well.…”

“…NMU was one of the centers in Pakistan where POCQI wa implemented. [10][11][12] The main purpose was to introduce four components of early essential newborn care to all the newborn babies to reduce neonatal mortality rate and improve care to mother and baby. Prior to this initiative by UNICEF, there was no set protocol for immediate care of newborn babies in labor room NMU and data was not collected regarding neonatal morbidity and mortality resulting from neonatal hypothermia, hypoglycemia and infection.…”