1. Reduction in Maternal and Child Mortality

► Significant reduction in preventable mortality occurred
    between 1990 and 2015 in SEAR:
      ♦ Maternal mortality declined by 64%
      ♦ Child mortality declined by 69%
      ♦ Neonatal mortality declined by 54%

► Decline was not enough to reach MDG 4 and 5 targets
    despite increased coverage of MNCH interventions

► One of the reason is poor quality of care.

2. WHO

3. Basic needs for good quality care at the health facility

► Infrastructure: Physical space, electricity,
    water, clean, safe surroundings
► Health workers: appropriate number and competencies
► Standard treatment guidelines are available
    and practiced
► Equipment, medicines, supplies, lab
► Case monitoring and actionable information

► Patient communication, respect and satisfaction

4. Logical Framework Inputs – Process- Outcome

Inputs

► Policies
► Physical infrastructure including basic amenities
► Finances
► Resources: People, Equipment, Supplies, Drugs
► Information Technology for case records. monitoring
► Support services and provisions for accompanying
    persons

5. Logical Framework Inputs – Process- Outcome

Process

6. Logical Framework Inputs – Process- Outcome

7. Global Framework for Quality of Care

8. Global Standards for MNH

9. Regional Framework for QOC

10. Regional QI framework: Systematic process

► Getting started: Preparation
► Develop / adapt national standards of care and
    assessment tool
► Assessment of current quality of care and identify
    gaps in quality
► Improvement process:
      ♦ Create improvement teams
      ♦ Root cause analysis of the quality gap
      ♦ Identify appropriate solution
      ♦ Implement the selected solution: Collaborative approach
► Reassessment:
      ♦ To find out if implementation of the solution has
       addressed the quality gap
► Success:
      ♦ Sustain: Supportive supervision, mentoring, continuous
     re-assessments
      ♦ Celebrate: Recognition, award
      ♦ Pick-up another quality gap and set in the improvement
     process
  ♦ Disseminate for scaling-up
► Failed: Apply another solution!
► Scale up

11. Regional Plan and Country Actions: Two Tracks

12. Regional Plan: Track – 2 Build capacity for QI at Health Facility

QI at Health Facilities:
► Improvements can be achieved with local action,
    usually without additional resources

► Main steps:
      ♦ Identify the problem area in quality of care
      ♦ Identify the causes of the problem
      ♦ Make changes to improve the quality of care –
         implement and learn
      ♦ Sustain the changed process (if successful)

13. Regional Plan: Track – 2 Build capacity for QI at Health Facility

► Tools for building capacity for QI at Health Facilities:
      ♦ In-service training / coaching
      ♦ On the Job mentoring – Supportive Supervision
      ♦ Pre-service education
      ♦ E-Learning resources
      ♦ Collaborative learning platform

14. POCQI Point of Care Quality Improvement

15. QI at Point of Care in health facility POCQI-4 Steps model

STEP 1: Identify the problem, form a team and write an AIM
              statement
STEP 2: Analyze the problem and measure quality of care
STEP 3: Develop and test changes
STEP 4: Sustain changes

16. Thanks

► Quality is never an accident…

► It is always the result of intelligent efforts!