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)

Expanded Family Planning Use Only

Expanded FP and Maternal Care Expanded Maternal and new born care only

360

140 140

5020

100

Effect of Family Planning use on Maternal death

Deaths related to Unintended pregnancy Deaths related to Intended Pregnancy

ROLE OF ENGENDERHEALTH

1 32Outcome 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.

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 site Whole 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/Internalsupervisors and staff• Facility level• Department or ward

level• Peers

Off-site/Externalsupervisors• 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

decision

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

Thank you