The project aims to achieve its goal of ‘sustainable quality improvement in maternal and newborn healthcare at public health facilities through the following strategies

Proposed Strategy:

• Ensuring improved availability of trained and adequate HR and resources at facilities according to the standards by mapping HR and training requirements, monthly labor room assessment, and monitoring.
• Creating a pool of trainers and district coaching team and their hand holding by Dakshata ToTs, support at district level Dakshata training and ToT on clinical and quality topics.
• Supporting District Hospitals and Community Health Centres for quality certification programs like LaQshya.
• To establish a quality culture in facilities by conducting regular quality circle meetings, ensuring the use of quality tools, and formulation of tangible action plans.
• To develop Continuing Medical Education (CME) blended learning program on managing sick pregnant women to improve the knowledge & skills of medical officers and specialists.
• Ensuring the conduct of state-driven Maternal Death Reviews (MDRs) and facility-level quality MDRs leading to insights and improvement in quality of services.
• Ensuring improved quality of maternal and newborn health services at Health and Wellness Centres (HWCs) and Gram Arogya Kendras through training and mentoring of CHOs, ANMs, and ASHAs.
• Theory of Change-The project tries to achieve its goal of ‘sustainable quality improvement in maternal and newborn healthcare at public health facilities’ through five major interventions.
• Facility level interventions for quality improvement involve Dakshata ToT, ToT on clinical and quality topics with the district coaching team, development of referral standards for CHCs and DHs. This will result in a pool of trainers at the district level. These trainers will conduct need-based as well as regular smaller sessions on quality and clinical topics for labor room staff. Mapping of HR and training status will be helpful to identify training needs at the facility level.
• Quality improvement projects will be useful for the staff to learn and apply quality tools. The facilities will be supported during the quality certification programs like LaQshya. The facility-level intervention will result in improved availability of adequate and trained HR, ultimately leading to improved quality of maternal and newborn health services at DHs and CHCs.
• Continued medical education is an important component of the project. JSS and CMC, Vellore will co-develop 12 modules for CME on the management of sick, pregnant women. In order to increase the reach of CMEs, a digital platform will be developed in order to create a blended learning program.
• Maternal death reviews are helpful to identify the gaps in service provision. Thus, training on the conduct of MDRs will be arranged and it will be ensured that MDR is conducted regularly at the district facilities. This will lead to gap identification and an action plan to bridge these gaps.
• The continuum of care intervention deals with ANMs, CHOs, and ASHA workers working close to the community. Refresher training will be arranged for these cadres and supportive supervision will be provided. Advocacy at the state, district, block, and sector levels will be a continuous process.

• The 6 intervention districts are predominantly tribal districts with high levels of under-employment, illiteracy, poverty, and food insecurity. This vulnerable population is completely dependent on public health facilities for health care needs and this is an attempt to improve the care ,especially to women and children with the help of this project.
• This intervention aims to improve the quality of care in the public health system through training, mentoring, and building a quality culture.
• Dakshata Training of Trainers and the District coaching teams create a pool of trainers and coaches in each district who will continue to help staff to provide better evidence-based care.