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Original article
Open Access

Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India

Gunjan Taneja, Enisha Sarin, Devina Bajpayee, Saumyadripta Chaudhuri, Geeta Verma, Rakesh Parashar, Nidhi Chaudhry, Jaya Swarup Mohanty, Nitin Bisht, Anil Gupta, Shailendra Singh Tomar, Rachana Patel, V.S. Sridhar, Anurag Joshi, Chitra Rathi, Dinesh Baswal, Sachin Gupta and Rajeev Gera
Global Health: Science and Practice September 2021, 9(3):590-610; https://doi.org/10.9745/GHSP-D-20-00368
Gunjan Taneja
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Enisha Sarin
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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  • For correspondence: esarin@jhsph.edu
Devina Bajpayee
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Saumyadripta Chaudhuri
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Geeta Verma
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Rakesh Parashar
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Nidhi Chaudhry
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Jaya Swarup Mohanty
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Nitin Bisht
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Anil Gupta
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Shailendra Singh Tomar
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Rachana Patel
cIndependent consultant, New Delhi, India.
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V.S. Sridhar
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Anurag Joshi
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Chitra Rathi
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Dinesh Baswal
dMinistry of Health and Family Welfare, Government of India, New Delhi, India.
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Sachin Gupta
eMaternal and Child Health, United States Agency for International Development–India, New Delhi, India.
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Rajeev Gera
aUnited States Agency for International Development-Vriddhi (Scaling up RMNCH+A Interventions) Project, New Delhi, India.
bIPE Global, New Delhi, India.
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Key Findings

  • Adopting an integrated implementation framework that combined training, mentoring, and quality improvement processes to improve the quality, equity, and dignity of care during the intrapartum and immediate postpartum periods, the Care Around Birth approach addressed key drivers of maternal and newborn mortality.

  • The approach refocused energy on facility-based quality processes that are currently central to efforts in reducing mortality and achieving Sustainable Development Goal targets.

Key Implications

  • Integrated implementation frameworks need to be aligned to the resources available and tailored to the ecosystem in which health programs operate.

  • Facility-level ownership and accountability by optimizing the engagement of health staff remain the fulcrum for any improvement effort. This however needs to be adequately supported by district and state-level health systems.

ABSTRACT

Background:

With the highest risk of maternal and newborn mortality occurring during the period around birth, quality of care during the intrapartum and immediate postpartum periods is critical for maternal and neonatal survival.

Methods:

The United States Agency for International Development’s Scaling Up Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions project, also known as the Vriddhi project, collaborated with the national and 6 state governments to design and implement the Care Around Birth approach in 141 high caseload facilities across 26 high-priority districts of India from January 2016 to December 2017. The approach aimed to synergize evidence-based technical interventions with quality improvement (QI) processes, respectful maternity care, and health system strengthening efforts. The approach was designed using experiential training, mentoring, and a QI model. A baseline assessment measured the care ecosystem, staff competencies, and labor room practices. At endline, the approach was externally evaluated.

Results:

Availability of logistics, recording and reporting formats, and display of protocols improved across the intervention facilities. At endline (October–December 2017), delivery and newborn trays were available in 98% of facilities compared to 66% and 55% during baseline (October–December 2015), respectively. Competency scores (> 80%) for essential newborn care and newborn resuscitation improved from 7% to 70% and from 5% to 82% among health care providers, respectively. The use of partograph in monitoring labor improved from 29% at the baseline to 61%; administration of oxytocin within 1 minute of delivery from 35% to 93%; newborns successfully resuscitated from 71% to 96%; and postnatal monitoring of mothers from 52% to 94%.

Conclusion:

The approach successfully demonstrated an operational design to improve the provision and experience of care during the intrapartum and immediate postpartum periods, thereby augmenting efforts aimed at ending preventable child and maternal deaths.

  • Received: July 8, 2020.
  • Accepted: June 1, 2021.
  • Published: September 30, 2021.
  • © Taneja et al.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00368

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Global Health: Science and Practice: 9 (3)
Global Health: Science and Practice
Vol. 9, No. 3
September 30, 2021
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Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India
Gunjan Taneja, Enisha Sarin, Devina Bajpayee, Saumyadripta Chaudhuri, Geeta Verma, Rakesh Parashar, Nidhi Chaudhry, Jaya Swarup Mohanty, Nitin Bisht, Anil Gupta, Shailendra Singh Tomar, Rachana Patel, V.S. Sridhar, Anurag Joshi, Chitra Rathi, Dinesh Baswal, Sachin Gupta, Rajeev Gera
Global Health: Science and Practice Sep 2021, 9 (3) 590-610; DOI: 10.9745/GHSP-D-20-00368

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Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India
Gunjan Taneja, Enisha Sarin, Devina Bajpayee, Saumyadripta Chaudhuri, Geeta Verma, Rakesh Parashar, Nidhi Chaudhry, Jaya Swarup Mohanty, Nitin Bisht, Anil Gupta, Shailendra Singh Tomar, Rachana Patel, V.S. Sridhar, Anurag Joshi, Chitra Rathi, Dinesh Baswal, Sachin Gupta, Rajeev Gera
Global Health: Science and Practice Sep 2021, 9 (3) 590-610; DOI: 10.9745/GHSP-D-20-00368
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    • ABSTRACT
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