Quality Assurance Project in Public Health Report on Quality Improvement in Primary Health Center By Applying in DAHOD and SABARKANTHA District Project Submitted to Integrated Population Development Project State Project Management Support Unit Gandhinagar Submitted By 1 Center for Action Research and Developmental Studies (A Unit of Vardaan Foundation) Prepared by Dr. Harshit Sinha September-December 2002 This is a workshop report supported by MoHFW, GOG, Gandhinagar and UNFPA regional office, Gandhinagar under IPD V project in Gujarat State. The report was developed by Vardan Foundation in collaborating efforts of Centre for Action Research and Developmental Studies – CARDS (A sub Unit of Vardaan foundation) Disclaimer The innovations made under the current project is solely belongs to the organization. Hence no part of findings and results of this project may be referred or reproduced (or disclose or reprinted or utilized in any form) other than the funding agencies (GOG) and other supporting agencies (UNFPA). The data inferences and opinion expressed in the report are not the opinion of funding agencies or any central or state authorities of India. CARDS served as Vardaan Foundation Publications and editorial coordinator. Restricted copies are available from: The Publication Division: Vardaan Foundation, Baroda, Gujarat, India www.varfound.org [email protected] First Draft 15th December 2002 Final Report 31st December 2002 Author: Dr. Harshit Sinha 2 Vardaan Foundation, Baroda An Appeal, those who believe in Quality work ) Every Beginning is hard – German proverb ) Quality is simple, people are complicated –Forsha ) Quality is not a sprint; it is a long distance event - Haunt ) A beginning is the most importan t part of the work – Plato. ) A good Beginning makes a good ending – English Proverb ) Plans are one things, action is another. – Murgatroyd and Morgan ) It takes a long time to bring excellen ce to maturity – Publilius Syrus ) If you think you can or you think can ’t, you’re probably right – H. Ford i Vardaan Foundation, Baroda Index Topics Page Preface iii Acknowledgement iv List of Figures v List of Tables vi List of Annexes vii Abbreviations viii Executive Summary ix Introduction 1 Background 1 Brief Introduction of Project Area 2 Designing Quality Assurance Project 6 Barriers in Designing Quality Assurance Project 8 Core Objectives of Quality Assurance Project 8 Pilot Strategy to Implement Quality Assurance Project 9 Task Planned 9 Task Accomplished 10 A: Designing Tool 10 B: Designing Training Manual 11 C: Designing Training Activities 11 D: Imparting Training to Service Providers 13 E: Introducing Rewarding System 20 F: Formation of Quality Circle Committee 21 G: Follow up Meeting 25 Data Description 26 Observations and Findings 27 1. Analysis of KAP Schedule 28 2. SWOT Analysis of PHCs 29 3. Description of 4ME 32 4: Human Behaviour 38 5: Feed Back 40 Discussion and Recommendations 42 Epilogue 47 Future Strategies 48 References 55 Annexes 58 ii Vardaan Foundation, Baroda Preface Today public health system requires substantial and careful reconsideration of the human resource management that includes training, supervision, accountability, performance appraisal, and reward/appreciation for the commendable work performance for any health programme operating in public health institutions. The need for preparing the quality assurance project arises out to implement ICPD agenda for decentralized planning, community participation at grassroot level, and quality centered services. Under the joint collaboration with UNFPA assisted IPD project with Government of Gujarat, Vardaan Foundation has designed Quality Assurance in Public Health and implemented in pilot phase in Dahod and Sabarkantha district. This is the first time in India when the component of “Quality” is systematically reviewed, designed and implemented by professionals. I hope that reader will benefit from pilot experience by taking up the challenges that lie ahead in improving efficiency in health services, changing the perceptions and behaviours of providers, patients, and public; reorientating the role of government; and regulating safety, efficacy, and, of course, QUALITY.* Dr. Harshit Sinha M.Sc; DCPA; Ph.D, Hon. Director, CARDS (Vardaan Foundation) Baroda. Email: [email protected] iii Vardaan Foundation, Baroda Acknowledgements My sincere thanks to all health officers and staff members who had giving time, efforts and sharing the thought to introduce and execute the concept of Quality in public health. My sincere thanks to the following members who had giving me an opportunity as well their useful suggestion for implementing the Quality Assurance project. UNFPA Regional Office : Mr. Arvind Pulikar, Regional Coordinator State Health Department : Mr. S.K. Nanda, Health Secretariat : Dr. K.N. Patel, Director Family Welfare : Dr. J.G. Gajjar, Assist Director Family Welfare State IPD Support Unit : Dr. S.R. Patel, SPO, IPD Project : Ms Jyotsana Shah, PO, IPD Project : Kamalaben Srimali, PO, IPD Project Dahod District : Mr. H.S. Mehta IAS, DDO : Dr. D.M. Patel, CDHO : Dr. S.B. Shah, ADHO Dahod IPD Project Team : Mr. J.P Parmar PO, IPD Project : Balwant Rathod, Computer Operator : Mr. Bhatia, Accountant Sabarkantha District : Mr. R.R. Chauhan IAS, DDO : Dr. R.K. Nagada, CDHO. : Dr. K.S. Patel, ADHO Sabarkantha IPD Team : Mrs. Haseenaben Mansoori, PO, IPD project : Mr. Himanshu Bhartia, Computer Operator : Mr. Ketan, Accountant. I wish the same support and cooperation for the future. Harshit Sinha M.Sc; Ph.D; DCPA iv Vardaan Foundation, Baroda List of Figures Page Figure 1: Map of Dahod district 03 Figure 2: Map of Sabarkantha district. 05 Figure 3: Model for Developing Quality Assurance Project 07 Figure 4: Four tier structure of quality circle in Public Health 21 Figure 5: Scope of the quality circle in public health system. 22 Figure 6: Comparative Analysis of Pre and Post Test for Medical officer 29 For Dahod district Figure 7: Comparative Analysis of Pre and Post Test for Medical officer 29 For Sabarkantha district v Vardaan Foundation, Baroda List of Tables Page Table 1: Important Demographic Variables of Dahod District 03 Table 2: Public Health set up in Dahod District 04 Table 3: Important Demographic Variables of Sabarkantha District 04 Table 4: Public Health set up in Sabarkantha District 05 Table 5: Status of Participants undergone QA project training in 15 Dahod district. Table 6: Status Participants undergone QA project training in 19 Sabarkantha district. Table 7: Summary of type of Information Schedule filled in the district 26 Table 8: Type of Respondent in the district 28 Table 9 Comparative analysis and classification of responses for pre test. 28 Table 10 Summarized information of SWOT analysis for PHCs 30 Table 11: Reported vacant post in the PHCs in comparison to national norms. 32 Table 12: Training status reported by the PHC medical officers 33 Table 13: Status of Construction with type of PHCs in both the district. 34 Table 14: Details of basic Amenities present in the constructed building 34 of the PHCs Table 15: The description of the units present in the PHCs. 35 Table 16: PHC requiring Repair and Furniture (in percentage) 36 Table 17: Average responses on the availability of items in different units 37 of the PHC (in %). Table 18: Average responses of the participant for human parameters 39 in both districts. Table 19: Reaction of the participants for the current subject. 41 Table 20: Expectation of participants in the matter of Quality of 41 Care through Quality Circle (N=150). vi Vardaan Foundation, Baroda List of Annexures Page Annexure 1: List of Participants from Dahod District. 58 Annexure 2: List of Participants from Sabarkantha District. 61 Annexure 3: List of Participants of Quality Circle Committee at PHC level from 62 Sabarkantha District. Annexure 4: List of Participants of Quality Circle Committee at PHC level from 64 Dahod District. Annexure 5: Minutes of District level Quality Circle Meeting at Dahod District. 65 Annexure 6: Minutes of District level Quality Circle Meeting at 68 Sabarkantha District. Annexure 7: Detail analysis of the Pre KAP information for 71 Dahod and Sarbarkantha district. Annexure 8: Detail analysis of the Pre and Post KAP information among 73 among medical Officers for Dahod and Sarbarkantha district. Annexure 9: Detail analysis of SWOT analysis for Dahod and 74 Sabarkantha district. Annexure 10: Details of the construction and repair work done Dahod and 78 Sabarkantha district. Annexure 11: Details of construction and the type of PHCs in Dahod and 80 Sabarkantha district. Annexure 12: Details of availability of each item for different services unit 86 in the PHCs of Dahod and Sabarkantha district. Annexure 13: Details of the content analysis for human behaviour information 90 Schedule for Dahod and Sabarkantha district. Annexure 14: Team Members of Vardaan Foundation, Baroda 97 vii Vardaan Foundation, Baroda AABREVATIONS ADHO : Additional District Health Officer ANC : Antenatal Care ANM : Auxiliary Nurse Midwives AV : Audio Visual BIECO : Block Information Education Communication Officer CHC : Community Health Center CDHO : Chief District Health Officer DDO : District Development Officer EOS : Emergency Obstetric Services FRU : First Referral Unit FHW : Female Health Worker GOG : Government of Gujarat HRD : Human Resource Development HQ : Head Quarter IMR : Infant Mortality Rate IEC : Information Education and Communication ICPD : International Conference on Population