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Applying simplified approaches for
quality improvement in MNCH/FP/N:
Early experiences from MCHIP
Bangladesh
Joby George
Chief of Party, MCHIP
Save the Children Bangladesh
MaMoni HSS: Overview
Goal
To improve utilization of integrated Maternal, Newborn, Child Health,
Family Planning and Nutrition (MNCH/FP/N) services
Objective
To increase availability and quality of high impact interventions through
strengthening district level local management and health system
1. Improve service readiness through critical gap management
Intermediate
Results
2. Strengthen health systems at district level and below
3. Promote enabling environment to strengthen district level health system
4. Identify and reduce barriers to accessing health services
Technical Priorities
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Health systems: Leadership and management, Decentralized planning and
management, HRH, RHIS, QA, Logistics management, National advocacy, Local
government
Newborn Health: Chlorhexidine, Helping Babies Survive (CNCP), Kangaroo
Mother Care, Sepsis Management, antenatal corticosteroids, Advanced
newborn care
Maternal Health: ANC/PNC, SBA, CEmONC/BEmONC, PPH, PE/E, referral
strengthening
FP: Informed choice, PPFP, LARC, LAPM
Nutrition: IYCF, maternal nutrition, SAM, MAM, WASH
Child Health: ORT/Zinc, IMCI, CCM, EPI
Community mobilization: CVs, CAG, interface with systems
mHealth: MAMA/Aponjon, automated RHIS
Population reach
• Total population: 12.2 million
• Children under-five: 1.3 million
• Births per year: 0.43 million
• ~ 8% of the country population
Quality improvement: context
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Competitive environment
Project’s history of several disjointed approaches to QI
– SBM-R as the key approach to QI
– Other approaches: regional quality improvement teams,
MPDR, joint supervision
– Large scale roll out of new interventions/ QI components
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Project’s national technical leadership in MNCH/FP/N
Government has prioritized quality of care
– New sector plan
– QI strategy and QI Secretariat
– Institutionalized QI support structures
Early lessons
• Successful in bringing QoC issues to the forefront –
national, district and health facilities
• Challenges:
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Co-existence of multiple QI approaches: branded models pose a barrier
Importance of coherence and coordination of various QI components
Low levels of local ownership and motivation
The standards and tools were too complex for certain levels of facilities
Unsurmountable health system challenges: absence of local solutions
Impossible to improve to address MNCH/FP/N issues in isolation
Simplified QI approach:
Principles
Keep it simple and generic
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Focus on improving crucial MNCH/FP/N services
Strengthen local ownership of QI process
Apply simple QI concepts and tools
Engage local stakeholders – beyond MOH providers
Improve quality of health services incrementally in stages
Link the multiple QI initiatives to complement each other
QI at all levels of service provision – facility and
community
Promote use of QoC data for local level reviews, planning
and action
Application of generic QI models
Identify
Gaps
Measure
Impact
Leadership
Ownership
Motivation
Develop
Action
Plan
Analyze
causes
Implementation by stages
Basic cleanliness
Stage 1
Bio-waste management
Minimum infection prevention
Advanced infection prevention
Stage 2
Organization of services, crowd management, logistics
Minimum clinical standards: EMEN, SBM-R
Comprehensive clinical standards & patient rights
Stage 3
Health systems: staff, commodities, supplies
Recognition/ Accreditation
Leadership and
accountability
MaMoni HSS Quality
Improvement Model
Program
reviews
Facility
Essential MNH
Management
Standards
IP, waste
(EMEN, SBM-R)
management,
High
patient flow
quality
mgt, Info Mgt,
MNCH/FP/
cleanliness
N services
Standard
Operating
Procedures
Improved
logistics planning
and mgt
(MNH & FP-SOPs,
IMCI, Nutrition)
Death reviews
(MPDR)
Motivation and
Ownership
Joint
Supervision
Visits
QI
Committees
Accreditation/
recognition
QI Action Plans
Clinical
Supervision
(RRQIT)
Facility Mgt
Committees
Local
Government
EMEN Standards
Clinical Care
• Evidence-based safe antenatal care is
provided.
• Evidence-based safe care is provided
during labor and childbirth.
• Evidence-based safe postnatal care is
provided for all mothers and the newborns.
Patient Rights
• Human rights are observed and the
experience of care is dignified and
respectful for every woman and newborn.
Cross-cutting
• Governance system to support the provision
of quality maternal and newborn care.
• Safe physical environment of the health
facility
• Qualified and competent staff are available
in adequate numbers
• Essential drugs, supplies and functional
equipment and diagnostic services
• Health information systems
• Continuity of care for all pregnant women,
mothers and newborns.
SBM-R Tools
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Birth spacing and family planning
Antenatal care
Normal labor, child birth, and immediate newborn care
Management of obstetric complications
Postpartum care
Sick newborn care
Infection prevention
Facility management
District level Health Systems Strengthening
Decentralized upazila level planning
session
Joint supervision visit by MOHFW
officials in Madhabpur, Habiganj
Automated MIS tools on computer tablets
to collect and use real-time data
A joint district quarterly performance
review meeting of Health and FP Managers
Local government constructed a new UH&FWC
in Horni, Hatiya upazila, Noakhali spending
BDT 1.1 million
Physical
infrastructural
preparedness:
Union FWCs
renovated, staffed to
provide 24/7
services
Staffing, Renovation and Waste Management
Kakailseo UH&FWC
Voice
Community level initiatives
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24,000 community volunteers, and community
groups
Interface between community volunteers and
frontline health workers – monthly community
microplanning meetings
Local elected representatives mobilized to take
action on MNCH-FP-N issues and strengthen
governance
Thank You