Networking: Innovative Solutions to Improve Adherence to Evidence-Based Practices around Childbirth

Experiences from India | Dakshata

Improved access to quality of care is inextricably linked with better maternal and neonatal health outcomes. Quality of care is a multi-dimensional concept that incudes availability of evidence-based guidelines, strengthened infrastructure, resources, enabling environment, attitude of health providers; all these in turn result in patients’ and providers’ satisfaction and improved health outcomes. Studies show that lower maternal and neonatal mortality correlate with an increased number of completed essential birth practices, regardless of which practices were done. Although minimum care standards and best practices for safe childbirth have been extensively described, there exist well recognized gaps in newborn and maternal care practices at birthing sites worldwide.

In India, Jhpiego, a nonprofit global health leader and Johns Hopkins University affiliate, collaborated with the State Government of Rajasthan, to implement an intrapartum and immediate postpartum quality improvement initiative, based on the WHO Safe Childbirth Checklist (SCC). The results of this initiative showed significant improvement in provider adherence to essential clinical practices, as well as 11% reduction in stillbirths and very early neonatal deaths. Seeing the favorable results of the initiative, the Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), launched a quality improvement initiative under the name ‘Dakshata’ (meaning- adroitness, in Hindi) in 2015, aimed at strengthening the quality of care during and immediately after childbirth through competent, skilled, and confident healthcare providers. With support from Children’s Investment Fund Foundation (CIFF), Jhpiego supported the rollout of the Dakshata program in Rajasthan and Andhra Pradesh, as well as the national scale-up activities through strategic technical assistance to MoHFW, GoI.

This session started with a short video introducing the Dakshata program. This was followed by a brief presentation by a state government official, giving an overview of Dakshata program in India. Following this, a detailed presentation was made by the Jhpiego India team on the various innovative strategies and solutions adopted under Dakshata to improve adherence to evidence-based practices around childbirth. The Jhpiego team discussed the various challenges encountered leading to low adherence to evidence-based practices around childbirth, innovative solutions adopted by the program team to address each challenge and program results to substantiate the effectiveness of these innovative solutions. The session ended with an open house where participants’ queries will be addressed by the state government official and Jhpiego India team. This session provided an opportunity to share the learnings and experiences from India, for improving provider adherence to evidence-based practices that can be replicated in other countries.