Ensuring quality of care

1. Ensuring quality of care SBA - Presentation 6 (b) Maternal Health Division Ministry of Health & Family Welfare Government of India

2. Community involvement Quality of care can be achieved only by sensitisation and involvement of: • the community • the family This helps in having a better outcome of pregnancy by ensuring: • Emotional support during pregnancy • Readiness of the family/community for timely assistance • Reaching the facility well in time for delivery of services Ensuring quality of care

3. Community involvement • Informing and involving the community in the process of improving women’s health will go a long way in bringing down maternal mortality • Community should be empowered to tackle health problems affecting their women Ensuring quality of care

4. How to improve health status of mother and infants • Enquire about knowledge of people regarding maternal morbidity and mortality in their area • Discuss role of families and communities in preventing maternal deaths • Share key messages on maternal and child health with community members Ensuring quality of care

5. How to improve health status of mother and infants Discuss ways in which families can help woman during pregnancy, labor and postpartum period: • Recognizing & responding to danger signs during these periods • Accompanying woman for delivery • Providing financial support • Communication between husband & wife Ensuring quality of care

6. How to improve health status of mother and infants Support the family & community in preparing action plan to respond to emergencies: • How to identify danger signs • Importance of rapid response to emergencies • Transport options available • What emergency obstetric services are available & where • Importance of blood transfusion in emergency • Need for blood donation Ensuring quality of care

7. How to improve health status of mother and infants Support to family in case of obstetric emergencies: • Listen to the family, they will need to discuss their hurt or sorrow • Show empathy • Tell the family as much they can understand about what is happening • Be honest and maintain the trust • If language/dialect is a barrier identify someone to translate for you Ensuring quality of care

8. How to improve health status of mother and infants Establish links with ASHAs, AWWs, SHGs and seek their cooperation: • Discuss how you can support each other • Respect their knowledge & influence in community • Share with them your information on maternal morbidity & mortality • Involve them in counseling sessions for families • Discuss recommendation that all deliveries (Home/Institution) be conducted by SBA Ensuring quality of care

9. Social review of maternal deaths • Report every maternal death to the ANM/M.O. for review • Undertake a social review of maternal deaths reported from villages under your area • Focus on finding social factors responsible for maternal death e.g. • Utilization of ANC services • Place of delivery • Who conducted the delivery • Availability of transport • Access to money • Preparedness and response time during emergency call The findings of social review to be shared in PRI / SHG meetings Ensuring quality of care

10. Community involvement Key messages • Raise awareness among the community regarding danger signs during pregnancy, labor delivery and postpartum period • Seek cooperation of other partners in the community such as : • Self help groups(SHGs) • Community based organizations (CBOs) • NGOs Ensuring quality of care

11. Importance of counseling • To avoid any problems arising due to complications during pregnancy • Avoiding legal cases against health providers in case of adverse pregnancy outcomes Hence the importance of disseminating correct information on how to make pregnancies safer among women and their families Ensuring quality of care

12. Points to be kept in mind while dealing with the woman and her family • Respect the woman’s dignity & privacy • Be sensitive and responsive to her needs • Be non – judgmental about the decision the woman and her family have made for her care • Provide counseling, if required, only after managingthe complication • Respect the right of women to receive maternity care services Ensuring quality of care

13. Rights of women who receive maternity care services Every woman receiving care has right to : • Privacy • Information about her health • Discuss her concerns • Know relevant information regarding procedures performed on her Ensuring quality of care

14. Supportive care during normal delivery • Ensure the woman has companion of her choice during labor & delivery • Encourage companion to take active part in the woman's care • Ensure privacy during and after delivery / event to the woman and her family Ensuring quality of care

15. Supportive care during emergency / complication Emotional and psychological reactions of woman and her family during emergency / complication • Denial • Guilt • Anger (towards health care staff / self) • Depression, disorientation Ensuring quality of care

16. General principles of communication and support during emergency/complication At the time of event • Listen to those who are distressed • Inform the woman / family about the emergency / complication • Be honest and maintain trust with the woman • If language a barrier to communication, identify a translator Ensuring quality of care

17. General principles of communication and support during emergency/complication After the event • Give practical assistance, information and emotional support • Respect traditional beliefs and customs and accommodate family's needs • Explain the problem to help reduce anxiety and guilt • Give written information, if possible Ensuring quality of care

18. Counseling and supportive environment Key messages • Respect the right of women to receive maternity care services • Respectful communication and empathy are most important elements of quality maternal care Ensuring quality of care

19. Janani-Shishu Suraksha Karyakram • Assures NIL out of pocket expenses in all Government Health Institutions for pregnant women & newborns • Launched by Ministry of Health & Family Welfare Ensuring quality of care

20. Janani-Shishu Suraksha Karyakram Entitlements for Pregnant Women • Free delivery • Free caesarian section • Free drugs and consumables • Free diagnostics (Blood, Urine tests and Ultrasonography, etc.) • Free diet during stay (upto 3 days for normal delivery and 7 days for caesarian section) • Free provision of blood • Free transport from home to health institution, between health institutions in case of referrals and drop back home • Exemption from all kinds of user charges Ensuring quality of care

21. Janani-Shishu Suraksha Karyakram Entitlements for Sick Newborn till 30 days after birth • Free and zero expense treatment • Free drugs & consumables • Free diagnostics • Free provision of blood • Free transport from home to health institution, between health institutions in case of referrals and drop back home • Exemption from all kinds of user charges Ensuring quality of care

22. Thank you Ensuring quality of care