Govt. Health Facilities

iGUNATMAC

Project iGUNATMAC (Quality Improvement in Maternal and Newborn Healthcare services) was started in 2016 in 16 public health facilities (district hospitals and CHCs) of 6 selected districts in Madhya Pradesh and two in Chhattisgarh. The objectives of this project are to build and enhance capacity of facility teams to apply quality standards through a process of training, mentoring and supportive supervision; to strengthen systems and processes in selected public health facilities so as to achieve quality standards set out in the GOI’s Quality Assurance guidelines; to improve accountability mechanisms in the facilities; to enable action to strengthen the continuum of care from community to facility; and to undertake advocacy to scale up initiatives for quality assurance in non-intervention facilities in both states.

Based on our assessments done while starting the project, it was realized that clinical practices and basic processes in the maternity wing required significant improvement. It was also realized that in order to improve practices and systems, training alone is insufficient to institutionalize improvements. Towards that, JSS devised on-site mentoring visits. These mentoring visits serve as practice sessions and checking adherence to protocols along with training. Mentoring and support visits focus on the identification and resolution of problems and helping to optimize the allocation of resources, while promoting teamwork. It focuses on working with the health staff in identifying and correcting problems, proactively improving the quality of service, and using data for decision-making. It is an immersive process with brainstorming and hand holding. This exercise is supplemented by Dakshata Training, a three-day skilled birth attendant training adopted by GoI. It focuses on correct clinical practices, preventing possible complications during childbirth and if complications still occur, then, how to manage them systematically at Staff Nurse and Medical officer level. A key advantage of Dakshata training is that it provides guidelines to doctors and nurses who work in remote areas with limited resources to provide appropriate care and if necessary take a call for timely referral. This can enable better management of patients before they can be referred to a higher center and hence reduce risk of morbidity. Since the number of staff to be trained is quite large, and it is difficult for external trainers (from iGunatmac) to conduct regular training, the Dakshata Training of the Trainer (TOT) workshop was initiated to create a pool of good local, government trainers at the district level. Not only nurses but also medical officers are regularly trained through programs such as a two-week training program of Clinical Observership and Training for Assistant Medical Officers at our Hospital and community program at Ganiyari on an array of topics relevant to management of illnesses and effective use of available infrastructure.

Along with training and mentoring, the iGUNATMAC project team is also a part of Maternal Death Reviews. Maternal or neonatal deaths help in identifying areas of improvement not only in the skills of providers but also processes and systems of the facility and take them to the local and state-level administrators. Lessons from these MDRs have inspired us to develop additional training modules for the care of sick pregnant women. The modules include care for a pregnant woman with severe anemia, altered mental status, jaundice, malaria, sepsis and septic shock, obstetric hemorrhage, and others. The MP government has 4 CMEs (3 days) for Obstetricians, medical specialists, Anesthetists and medical officers to cover these topics, which have been conducted by resource persons from JSS. Although the mentoring program for nursing staff aims at improving nursing care and nurse-led practice in the facility, improvement in the overall quality of care is possible only when the facility staff works as a team. Maternal death review helps us in building accountability of the facility team, especially doctors, allied departments like a blood bank, laboratory, pharmacy, and facility administrators.

Find The Report Here
iGunatmac Report
iGunatmac Report 2020-21

Find Detailed Report Here
Summary report
In service mentoring
Maternal death review