Recording and materials from the webinar on 'Adapting and adopting quality of care standards in facilities: the experience of Bangladesh'

Shilpi Rani with her husband and new born child at Paikpara, Thakurgaon Sadar, Bangladesh, in April 2011. ©UNICEF/Siddique
25.10.2018

The Network for Improving Quality of Care for Maternal, Newborn , and Child Health, held a webinar on ‘Adapting and adopting quality of care standards for maternal and newborn health in facilities: the example of Bangladesh’ on 22 October.

Dr Aminul Hassan, Deputy Director of the Quality Improvement Secretariat within the Ministry of Health, explained how four facilities in the Narsingdi district conducted PDCA cycles to improve the quality of ANC, labour monitoring, the administration of oxytocin, the management of maternal complications, the management of sick newborns, and essential/immediate newborn care. He also presented a model to expand quality improvement in Bangladesh.

Dr Nazma, Jr. Consultant Gynaecologist at Narshingdi Hospital, presented some of the work done at the facility level and results so far. 

Listen to the webinar recording

See their presentation, as well as the questions and answers in the comment section below.

Resources:

See the details on all previous Quality of Care Network’s webinars:  http://qualityofcarenetwork.org/about/webinars

Comments

Why was the partograph not used?

ANSWER

During our assessment, we found that the senior staff nurses were not being recently trained on normal delivery.  Because of lack in knowledge, they were not practicing the use of partograph. In addition, there was also no supply of pantograph for use. The local administration was unaware of the supply shortage but they immediately responded after the assessment findings were disseminated.

Who did you involve in QI team; did you include non health staff?

ANSWER

Both health and non-health staffs are involved. Depending on the QI problems the work improvement team members are selected. For example- for improving the infection prevention both health and non health staffs are involved.

Any efforts to involve community representatives?

ANSWER

The community representatives are member of the facility quality improvement committee. They meet every month and supervise the work improvement committee.

How do teams sustain motivation after improvements? Is there a drive to continue after one problem is solved?

ANSWER

We have just completed the first round of PDCA. The teams are continuing their efforts to achieve 100% of the target. However, it seems like regular meetings, acknowledgement appreciations by the facility manager helps them to sustain the motivation.

A lot of the challenges seem to be systems challenges, and beyond the control of the facility, how can the district help, and what was the experience in this district case?

ANSWER
 

The leadership at the district level needs to be strong and motivated. In some other districts like Laxmipur and Noakhali , we have seen that if the local representatives are involved they try to fund local solutions and solve the resource related issues locally.

Good to see increasing the use of partograph. Will it help to reduce the high CS rate?

ANSWER

Definitely, partographs help to decide for the CS. As you can see in the data slides, the rate of CS is still low in the district hospital.

What lessons can the Quality Improvement Secretariat (QIS) and MaMoni share with other countries based in this pilot implementation, specially what not to do when implementing in a pilot district?

ANSWER

QIS is planning to share the lessons learning at national level, so that it can be scaled up throughout the country. The key challenges for improving quality at the facilities are availability of the human resource and patient load. If the referral system is strengthened and need based allocation of human resource ensured, then it can play a vital role in improving the quality of care at the facilities.

KMC should also to be started asap. It will be very essential for the mother and baby

The KMC corners are ready. It will be started at the facility soon.

Is the use of partograph correct now?

ANSWER

We are still missing 30% of cases where partographs are not being done.

How will you support midwifery care providers to stay at the health centres? Motivation will not be enough (refer to the WHO document on "Midwives Voices, Midwives realities".

ANSWER

At national level, government is taking initiatives to empower the midwives. For example- the national maternal health day theme of this year was Midwives. At local level, Civil Surgeon has taken initiatives to place midwives at the facilities and identified their roles and responsibilities.

How can this excellent work be sustained?

ANSWER

Strengthened monitoring and supervision both at facility level and at national level can sustain the achievements.

Is there any plan to do the end line assessment? if so when?

ANSWER

Yes, after second round of the PDCA.

Is there enough facilities to manage obstetrical emergency in the maternal hospitals

ANSWER

Yes. There are enough public and private facilities to manage the cases.

We know that training is not enough. Clean safe accommodation for midwives is urgently needed, along with respectful working relationships amongst the team of midwives (which Bangladesh now has), nurses and doctors

Do have any baby friendly hospital in your country

ANSWER

Yes. Narsingdi district hospital is one of the baby friendly hospitals.

For the work in Narsingdi: is 1 PDCA= addressing one problem (oxytocin in a minute) or 1 PDCA= trying one solution for one root cause of a problem (attaching partograph with case file)?

ANSWER

1 PDCA for one problem. That PDCA tries to address all the possible causes of the problem.

Thanks for this wonderful presentation.  However, the given limited data points, what are the strategies to sustain the observed improvement before opting new areas of intervention/practices ?

ANSWER

More options for data collection need to be explored. The data collection process needs to be realistic and simplified. Collecting data regularly helps to decide the cycles. A focus was on building the capacity of the teams to collect data at regular interval.

Every health care organization started CPD program for all the health care professionals. Did they started to do that, because it will be a very good source of attaining knowledge and best guidelines?

ANSWER

This is a very good idea. Considering the Bangladesh’s perspective, it is challenging to start the CPD immediately. However, we plan to do it in future.

Is the PDSA cycle linked with Maternal and Perinatal death surveillance and response (MPDSR) if MPDSR is also implemented in Narsingdi district hospital?

ANSWER

We haven’t linked MPDSR with the PDCA till now but we are planning to do it in future

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