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Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation
Quality of intrapartum care is essential for improving pregnancy outcomes; several models for improving performance are tested, globally. Dakshata is one such WHO SCC-based national program—improving resources, providers’ competence, and accountability—in public sector secondary care hospitals of In...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022249/ https://www.ncbi.nlm.nih.gov/pubmed/36962724 http://dx.doi.org/10.1371/journal.pgph.0000530 |
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author | Singh, Samiksha Kannuri, Nanda Kishore Mishra, Aparajita Gaikwad, Leena Shukla, Rajan Tyagi, Mukta Chamarthy, Swecha |
author_facet | Singh, Samiksha Kannuri, Nanda Kishore Mishra, Aparajita Gaikwad, Leena Shukla, Rajan Tyagi, Mukta Chamarthy, Swecha |
author_sort | Singh, Samiksha |
collection | PubMed |
description | Quality of intrapartum care is essential for improving pregnancy outcomes; several models for improving performance are tested, globally. Dakshata is one such WHO SCC-based national program—improving resources, providers’ competence, and accountability—in public sector secondary care hospitals of India. Andhra Pradesh state devised strategy of mentoring by the handpicked member from within the obstetric team, supported by external technical partner. We evaluated the effectiveness and assessed contextual factors to success of the program. We conducted pre and post mentoring mixed-method surveys to evaluate the change in evidence-based intrapartum and newborn care practices and stillbirth rates, across 23 of 38 eligible hospitals. We directly observed obstetric assessments and childbirth, extracted data from casesheets and registers, interviewed beneficiaries and conducted facility surveys. We in-depth interviewed stakeholders from state, district and facility managers, mentors and obstetric staff, and external managers for theory-driven qualitative assessment. After one year we found, average adherence to practices sustained high during admission (81%, 81%); improved during childbirth (78%, 86%; p = 0.016); moderate within one hour of birth (72%, 71%), and poor postpartum care before discharge (46% to 43%). Stillbirths reduced from 11(95% CI, 9–13) to 4(3–5) per 1000 births (p<0.001). Some practices did not improve even after sustained reinforcement. Commitment from state, engaging district officers, monitoring and feedback by external managers enabled supportive setting. The structured training and mentoring package, and periodic assessments delivered under supervision ensured the standards of mentoring. The mentoring model is acceptable, effective, less costly and scalable; appears sustainable if state commits to institutionalising a long-term mentoring with adequate monitoring. We conclude that the SCC-based mentoring and skill building program showed improvement in practices during childbirth while it sustained high levels of care during admission, but no improvement in postpartum care. The state needs to monitor and ensure continuous mentoring with required infrastructural support. |
format | Online Article Text |
id | pubmed-10022249 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-100222492023-03-17 Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation Singh, Samiksha Kannuri, Nanda Kishore Mishra, Aparajita Gaikwad, Leena Shukla, Rajan Tyagi, Mukta Chamarthy, Swecha PLOS Glob Public Health Research Article Quality of intrapartum care is essential for improving pregnancy outcomes; several models for improving performance are tested, globally. Dakshata is one such WHO SCC-based national program—improving resources, providers’ competence, and accountability—in public sector secondary care hospitals of India. Andhra Pradesh state devised strategy of mentoring by the handpicked member from within the obstetric team, supported by external technical partner. We evaluated the effectiveness and assessed contextual factors to success of the program. We conducted pre and post mentoring mixed-method surveys to evaluate the change in evidence-based intrapartum and newborn care practices and stillbirth rates, across 23 of 38 eligible hospitals. We directly observed obstetric assessments and childbirth, extracted data from casesheets and registers, interviewed beneficiaries and conducted facility surveys. We in-depth interviewed stakeholders from state, district and facility managers, mentors and obstetric staff, and external managers for theory-driven qualitative assessment. After one year we found, average adherence to practices sustained high during admission (81%, 81%); improved during childbirth (78%, 86%; p = 0.016); moderate within one hour of birth (72%, 71%), and poor postpartum care before discharge (46% to 43%). Stillbirths reduced from 11(95% CI, 9–13) to 4(3–5) per 1000 births (p<0.001). Some practices did not improve even after sustained reinforcement. Commitment from state, engaging district officers, monitoring and feedback by external managers enabled supportive setting. The structured training and mentoring package, and periodic assessments delivered under supervision ensured the standards of mentoring. The mentoring model is acceptable, effective, less costly and scalable; appears sustainable if state commits to institutionalising a long-term mentoring with adequate monitoring. We conclude that the SCC-based mentoring and skill building program showed improvement in practices during childbirth while it sustained high levels of care during admission, but no improvement in postpartum care. The state needs to monitor and ensure continuous mentoring with required infrastructural support. Public Library of Science 2022-08-16 /pmc/articles/PMC10022249/ /pubmed/36962724 http://dx.doi.org/10.1371/journal.pgph.0000530 Text en © 2022 Singh et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Singh, Samiksha Kannuri, Nanda Kishore Mishra, Aparajita Gaikwad, Leena Shukla, Rajan Tyagi, Mukta Chamarthy, Swecha Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title | Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title_full | Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title_fullStr | Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title_full_unstemmed | Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title_short | Effect of WHO-SCC based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in Andhra Pradesh, India: Pre-post mixed methods evaluation |
title_sort | effect of who-scc based intra-department mentoring program on quality of intrapartum care in public sector secondary hospitals in andhra pradesh, india: pre-post mixed methods evaluation |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022249/ https://www.ncbi.nlm.nih.gov/pubmed/36962724 http://dx.doi.org/10.1371/journal.pgph.0000530 |
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