Quality of Care in India
India has made remarkable improvements in maternal and child health related indicators and is further committed to ensure safe motherhood to every pregnant woman. In its National Health Policy 2017, India has committed to reduce:
- Maternal mortality ratio (MMR) from current levels to 100 by 2020
- Under five mortality to 23 by 2025
- Infant mortality rate to 28 by 2019
- Neo-natal mortality to 16 and still birth rate to “single digit” by 2025
While the country has been successful in expanding the coverage of maternal health services across the population, focus has now shifted to ensure quality services. Recent evidence highlights that improving care for mothers and babies around the time of birth can lead to 46% reduction in maternal mortality and 40% reduction in still births and neonatal deaths.
India has launched two key initiatives to address the current gaps in care for pregnant mothers and accelerate the pace of decline in MMR.
The first one, Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), launched in 2016 targets the needs of pregnant mothers for quality antenatal examinations. Under PMSMA, doctors in both the public and private sector examine expecting mothers on the 9th of every month. So far, more than 1.8 crore antenatal check-ups (in addition to four ANC checkups) have been conducted across the country under this program ensuring that pregnant mothers receive at least one specialist antenatal examination during their pregnancy.
The second one, the Labor Room and maternity OT Quality Improvement Initiative (LaQshya) launched in 2017 seeks to improve the quality of intrapartum and immediate post-partum care provisions in public facilities. LaQshya is an ambitious national initiative focused on improving the positive birthing experience and respectful maternity care for all women attending public health institutions. LaQshya implementation involves improving infrastructure upgradation, ensuring availability of essential equipment, providing adequate human resources, capacity building of health care workers and provision of ongoing quality improvement support to the health facilities.
The Ministry of Health has provided the overall guidance to the states with a package of interventions and support for implementation. Six quality improvement cycles have been developed to support the states in implementing them, as per the gaps identified during facility assessments. These quality improvement cycles cover the different evidence-based practices for improved perinatal and post-natal care addressing post-partum hemorrhage, perinatal asphyxia, sepsis, eclampsia, respectful maternity care and ensuring appropriate referral for mothers.
The Government of India has also taken a historic and landmark policy decision to roll out midwifery services in the country to improve the quality of care of maternity services, ensure task shifting among the health personnel and ensure respectful care to pregnant women and newborns.
Photo: Bindu Devi with her son Sahil Kumar at the Bhagwanpuri Raiti village Anganwadi health clinic in Bihar, India, in June 2010. ©UNICEF/Graham Crouch