TCIHC’s QA Approach Leads to National Recognition for Behrampur’s UPHCs

Oct 9, 2020

Contributors: Debabrata Bhuniya, Meenakshi Dikshit and Hitesh Sahni

Staff nurse and ASHA counsel a client on family planning.

Quality assurance (QA) is one of the nine high-impact family planning approaches that The Challenge Initiative for Healthy Cities (TCIHC) uses when working with city governments. TCIHC provides technical support to urban primary health centres (UPHCs) to establish quality improvement committees, conduct a periodic quality assessment using a simplified checklist, develop and monitor a plan of action and ultimately be certified by the district quality assurance team for offering quality services.

After TCIHC partnered with the City Health Department in Berhampur, Odisha, to implement the QA approach in all seven of its UPHCs, quality measures improved significantly. This improved quality was recognized nationally with all seven TCIHC-supported UPHCs of Berhampur earning the Kayakalp Award.

In 2019-2020, all seven TCIHC-supported UPHCs of Berhampur earned a Kayakalp award. Three UPHCs received first place and two others were recognized as runners up while the remaining UPHCs received a commendation award. Kayakalp Awards are a national initiative launched in 2015 to improve and promote the cleanliness, hygiene, waste management and infection control practices in public health care facilities and incentivize high-performing facilities.

Mr. Lamodar Digal, City Program Manager In-charge, National Health Mission (NHM) Berhampur, shared why this recognition is significant:

All seven UPHCs of the city achieved Kayakalp Award in 2019 as they followed QA guidelines, which improved the quality aspects of service delivery including hygiene, infection control mechanism and supported UPHCs in internal facility assessment. This is significant because in 2017-18 UPHCs were new. There were barriers related to biomedical waste management, training of staff on quality parameters and most of all since NUHM [National Urban Health Mission] was new, no other department took ownership [of quality assurance]. At this time, TCIHC worked with the city health team and actually gave shape to the vision of the Commissioner of Berhampur who wanted to ‘Make UPHCs the first choice of treatment for people” of Berhampur and wanted them to qualify for the highest certification of quality, which is ‘Kayakalp’ and National Quality Assurance Standards (NQAS).”

In 2017-18, UPHCs provided only oral contraceptive pills and service providers, while Auxiliary Nurse Midwifes (ANMs), staff nurses and Accredited Social Health Activists (ASHAs), were unaware of the full array of method choices and were not trained to provide them. TCIHC helped coach ASHAs on counseling techniques, organized hands-on trainings of ANMs on all method choices, and ensured staff nurses received training on the provision of intra-uterine contraceptive device (IUCD) and the injectable contraceptive Antara. As a result of these efforts, family planning became an integral part of the services provided at the UPHC. Digal said TCIHC support made the difference.

Before TCIHC’s technical support, we did not even imagine that one day we would be able to provide expanded choices of family planning, including long-acting reversible methods at UPHC.”

But expanding the availability of IUCDs and injectables made quality a more prominent concern. As a result, TCIHC began supporting the quality assurance approach by having field program service assistants (FPSA) – who coach UPHC staff – incorporate family planning in the quality improvement meeting at UPHCs and district quality assurance committee (DQAC) meetings at the district level. This particular step not only prioritized issues in family planning but also helped uncover many other gaps related to quality, infrastructure, supplies, etc. These issues were discussed during DQAC meetings as well. The support also included the introduction of a simple checklist for family planning based on the NQAS guidelines. This simple checklist helped UPHC staff to self-monitor quality parameters. In addition, each UPHC in Berhampur created a family planning corner, which provided privacy for family planning counseling and services.

As a result of these measures, family planning was strengthened at each UPHC and this contributed to increased scores for both Kayakalp and NQAS and eventually helped each UPHC win both. Digal explained the mindset shifts that the QA approach has sparked at the UPHCs and among the communities that they serve:

Our UPHCs are now ‘AMA clinic’ (meaning ‘Our Own Clinic’) in the real sense. ‘AMA clinic’ was the slogan given by the Berhampur Municipal Corporation (BeMC), but it turned into a reality once we, the city government, got TCIHC’s technical support. Our people around UPHCs are happy as there is no need to go to the district hospital or higher level hospital for primary health services, including family planning.”

These QA measures of Berhampur inspired several cities in Odisha and the neighboring state of Madhya Pradesh to visit Berhampur UPHCs to learn more. Two more cities supported by TCIHC – Rourkela and Puri – also won Kayakalp commendation awards, thus validating that the right family planning approach can help a UPHC score for Kayakalp award. In addition, since TCIHC’s inception in 2017, all seven UPHCs of Berhampur have increased the availability of all family planning choices for the urban poor population, especially reversible methods, such as IUCD, injectable contraceptive and non-hormonal pills.

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