Development of a Quality Assurance Procedure for Reproductive Health Services for District Public Health Systems: Implementation and Scale-up in the State of Gujarat Frontiers in Reproductive Health Program, Population Council

This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of Cooperative Agreement No. HRN-A-00-98-00012-00 and Subproject number 5800.53075. The contents are the responsibility of the FRONTIERS Program and do not necessarily reflect the views of USAID or the United States Government. This project, entitled was carried out in two districts each in Gujarat and Maharashtra states. It confirmed that Quality Assurance (QA) checklists and an implementation manual, developed by the USAID-funded Frontiers in Reproductive Health (FRONTIERS) Program of the Population Council in collaboration with UNFPA/India, are useful and effective tools that the Ministry of Health and Social Welfare (MOHFW) can use to monitor the quality of services provided by health facilities. It also demonstrated that this QA mechanism can be easily institutionalized at the district level management. The QA procedure involves a series of visits to health facilities by a team of three district level health officials, called the Quality Assurance Group (QAG). This team uses the QA checklists to review the readiness of the facility to offer services and the measures the quality of services provided. Before the QAG team leaves the facility, any gaps in readiness or quality identified by the team members are communicated to the Medical Officer in-charge (MO I/C) and actions are suggested for improvement. Further visits are made to the facility every four months, during which progress in addressing the gaps identified previously is assessed. The QA checklists provide easy procedures to provide an aggregated score for each individual facility with respect to input (readiness), process (how the service is delivered) and outcome (performance). Comparison of the data from the QA visits demonstrated that the data obtained through the QA visits have been used by the district officials and the MO I/Cs of the facilities to address the gaps identified in the services. Many of the facilities that had scored a C or B grade for their readiness had moved to a higher grade, indicating improvements in the facilities. Similarly the measures of service quality also showed some improvements, although the quality of services generally remained below a desirable level and seems to require more attention than simply improving readiness. The findings of the pilot study were disseminated at several fora, and the QA Manual and Checklists were formally launched by the PHN Division Chief of USAID/India. After …