Govt. of Gujarat - Health and Family Welfare Department
Govt. of Gujarat - Health and Family Welfare Department
Govt. of Gujarat - Health and Family Welfare Department
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Quality <strong>Health</strong> care Services<br />
in Public <strong>Health</strong> Institutions<br />
<strong>Govt</strong>. <strong>of</strong> <strong>Gujarat</strong><br />
Dr J L Meena<br />
State Quality Assurance Officer<br />
Commissionerate <strong>of</strong> <strong>Health</strong> <strong>and</strong><br />
<strong>Family</strong> <strong>Welfare</strong><br />
G<strong>and</strong>hinagar (<strong>Gujarat</strong>)
What is Quality<br />
“Right work at the right time at the right place for<br />
the right Client by the right person”.
Quality Assurance - components<br />
Two main components <strong>of</strong> Quality Assurance<br />
• Quality Assessment<br />
• Quality Improvement<br />
Quality assessment:<br />
– Supervisors to identify the gaps in performance <strong>of</strong><br />
PHC/CHC MOs <strong>and</strong> other staff.<br />
Quality improvement:<br />
– Reducing the identified performance gaps.
QA Checklists<br />
Six QA checklists developed <strong>and</strong> introduced at<br />
district management level<br />
Form I Facility Readiness (INPUT)<br />
Form II Quality <strong>of</strong> services provided. From records<br />
(PROCESS)<br />
Form III Quality <strong>of</strong> F.P services provided.<br />
Observed (PROCESS)<br />
Form IV Maternal <strong>and</strong> newborn care services.<br />
Records & Observed (PROCESS)<br />
Form V Trend <strong>of</strong> number <strong>of</strong> services provided<br />
Record (OUTPUT)<br />
Form VI Summary report. Scores based on check<br />
list 1-5
Quality Assurance- Process flow<br />
QA applies broadly to an entire cycle <strong>of</strong> tasks to<br />
improve the quality <strong>of</strong> care.<br />
Problem identification<br />
Verification <strong>of</strong> the problem<br />
Identification <strong>of</strong> what is correctable<br />
Initiation <strong>of</strong> improvements<br />
Continual review to assure that identified problems<br />
have been adequately corrected<br />
No further problems in the process <strong>of</strong> service delivery
QIP Strategy Dahod District<br />
Quality Assurance (QA) Program Implementation Process<br />
National Consultation<br />
State Level Consultation<br />
District Level Training, Facility MOs Orientation<br />
Quarterly visits by QAG team to PHCs/CHCs & Follow-up
Comparison <strong>of</strong> Quality Assessment between<br />
Baseline to QA 3 rd visits, Dahod<br />
Total Scores <strong>of</strong> QA Inputs Achieved by Each Facility (N=13)<br />
Baseline Survey<br />
3rd quarter visit<br />
Grade D<br />
8%<br />
Grade A<br />
0%<br />
Grade B<br />
8%<br />
Grade C<br />
0% Grade D<br />
0%<br />
Grade C<br />
84%<br />
2nd quarter visit<br />
Grade B<br />
23%<br />
Grade C<br />
0%<br />
Grade D<br />
0%<br />
Grade B<br />
46%<br />
Grade A<br />
54%<br />
Score<br />
A =76+%<br />
B = 51-75%<br />
C = 26-50%<br />
D =1-25%<br />
Grade A<br />
77%
Percent<br />
Change in QA Scores (Input)<br />
Baseline to 3rd QA Visit, Dahod*<br />
100<br />
90<br />
80<br />
70<br />
60<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Devgarh Baria ©<br />
Piplod ©<br />
B<strong>and</strong>iwar<br />
Bordi<br />
Garwada ©<br />
Kanjeta<br />
Mirakhedi<br />
Jesawada<br />
Gagardi<br />
Timarda<br />
Pethapur ©<br />
Gamdi<br />
Dungar<br />
Limkheda ©<br />
Vansiya<br />
Chhaparwada<br />
Fatepura ©<br />
Baseline QAG-I QAG-II QAG-III<br />
“*” Score based on presence <strong>of</strong> 85 items/facilities<br />
M<strong>and</strong>or<br />
Margala<br />
Sevaniya
Percent<br />
100<br />
90<br />
80<br />
70<br />
60<br />
Change in QA Scores (Process & Output)<br />
Baseline to 3rd QA Visit, Dahod*<br />
50<br />
40<br />
30<br />
20<br />
10<br />
0<br />
Gagardi<br />
B<strong>and</strong>iwar<br />
Devgarh Baria ©<br />
Bordi<br />
Mirakhedi<br />
Jesawada<br />
Timarda<br />
Piplod ©<br />
Fatepura ©<br />
Limkheda ©<br />
Garwada ©<br />
Kanjeta<br />
Pethapur ©<br />
Dungar<br />
Chhaparwada<br />
Vansiya<br />
Sevaniya<br />
Gamdi<br />
M<strong>and</strong>or<br />
Margala<br />
Baseline QA-O1 QA-O2 QA-O3<br />
“*” Score based on 34 indicators<br />
After the Success <strong>of</strong> Pilot project, we decided to implement in all districts <strong>of</strong> <strong>Gujarat</strong>
QIP Implementation Process in all Districts<br />
QIP One Day Orientation workshop for State, Regional & District<br />
level <strong>of</strong>ficers. (3 Batches Total Participants- 128)<br />
QIP Two Day Orientation workshop for ADHO <strong>and</strong> BHOs<br />
(7 Batches Total Participants- 263)<br />
District Level QIP Two Day Orientation workshop for District QA Team And Block<br />
QA Team (Batches-25 Total Participants-628)<br />
District Level QIP One Day Orientation workshop for MO PHC & CHC Superintendents<br />
(Batches-25 Total Participients-1275)<br />
Select Facilities & Prepared visit plan By District QA Team & Block QA Team<br />
District QA Team Visit CHCs & FP Camps<br />
Block QA Team Visit PHCs<br />
Prepared Action Taken Report & MIS Report<br />
Prepared Action Taken Report & MIS Report<br />
QAG Group Meeting with CDHO & DDO <strong>and</strong> finalized the Action Taken Report <strong>of</strong> District<br />
<strong>and</strong> Send to the Region <strong>and</strong> the State
DQAG TEAM PLAN<br />
1. CDHO + RCHO + DPHN(MCH)<br />
2. ADHO + DLO + DIECO + EMO<br />
3. CDMO + ADHO + DPHN(FP)<br />
4. RCHO + DTO + Principal (TC)<br />
BLOCK QAG TEAM PLAN<br />
1. BHO + BIECO + Block PHN
QAG Visit Schedule<br />
S.<br />
no.<br />
Name <strong>of</strong> CHC<br />
Date <strong>of</strong> visit<br />
(Jan 07)<br />
Date <strong>of</strong> Visit<br />
(Feb 07)<br />
Date <strong>of</strong> Visit<br />
(March 07)<br />
1 Garbada 2 nd Jan 07<br />
2 Pethapur 9 th Feb 07<br />
3 Limkheda 6 th March 07<br />
4 Fatepura 9 th Jan 07<br />
5 Dev. Bariya 20 th March<br />
07<br />
6 Piplod 16 th Feb 07
DQAG Monthly Meeting<br />
S.<br />
No.<br />
Type <strong>of</strong> meeting Jan 07 Feb 07 March 07<br />
1 ADHO + BHOs<br />
(Monthly Meeting)<br />
2 CDHO + QAG<br />
Members (Monthly<br />
Meeting)<br />
3 DDO, RDD + QAG<br />
Members (Quarterly<br />
Meeting)<br />
26th Jan 07 23rd Feb 07 23rd March 07<br />
31st Jan 07 27th Feb 07 27th March 07<br />
… … 30 th March 07<br />
4 CHC superintendents<br />
& PHC Medical <strong>of</strong>ficers<br />
(Monthly Meeting)<br />
2nd Feb 07 2nd March 07 6 th March 07
Action taken report Form no:-2<br />
S.N.<br />
Name <strong>of</strong> PHC/CHC<br />
Action point A: STAFF AND<br />
TRAINING<br />
1 Gangardi • Required BEmoC training for MO<br />
PHC.<br />
• Pharmacist post filled as soon as<br />
possible or regularized deputation <strong>of</strong><br />
pharmacist.<br />
• Required practical training to LT for<br />
RTI/STI.<br />
Identified the problem by QA Team<br />
Action Point B: INFRASTRUCTRE NEEDS<br />
• Required repairing <strong>of</strong> windows, maintenance<br />
beds, signboard for clinic time.<br />
• Required repairing <strong>of</strong> PHC vehicle.<br />
• Required signboard for ambulance charges,<br />
suggestion box & solid waste containers in each<br />
room.<br />
• Required well marked signboard exhibiting<br />
clinic timings <strong>and</strong> all the services providing by<br />
this center.<br />
2 Jesabada • Required BEmoC training for MO<br />
PHC.<br />
• Pharmacist post filled as soon as<br />
possible or regularized deputation <strong>of</strong><br />
pharmacist.<br />
• Required practical training to LT for<br />
RTI/STI.<br />
• Staff nurse also required training for<br />
RTI/ STI.<br />
• Required repairing <strong>of</strong> windows, cleanness,<br />
painting, <strong>and</strong> signboard for clinic time.<br />
• Required repairing <strong>of</strong> PHC Residence<br />
quarters.<br />
• Required signboard for ambulance charges,<br />
suggestion box & solid waste containers in each<br />
room.<br />
• Required well marked signboard exhibiting<br />
clinic timings <strong>and</strong> all the services providing by<br />
this center.
Action Taken Report Form:-3<br />
During 1 st QAG Meeting<br />
Name <strong>of</strong><br />
Facilities<br />
Problem identified by QAG during their<br />
visit at the facility<br />
Who will take action to<br />
sort out the problem<br />
(CDHO/DDO)/RDD/<br />
State ?<br />
What Action has been taken to sort out<br />
the problem ?<br />
Gangardi<br />
• Required BEmoC training for MO<br />
PHC.<br />
• Pharmacist post filled as soon as<br />
possible or regularized deputation<br />
<strong>of</strong> pharmacist.<br />
• Required practical training to LT<br />
for RTI/STI.<br />
CDHO/DDO<br />
1. Organized BEmoC & RTI Training to<br />
MO & staff nurse.<br />
2. Take permission from higher<br />
level for Pharmacist post fulfilled.<br />
3. Organized RTI/STI Practical<br />
training to LT.<br />
Jesabada<br />
• Required BEmoC training for MO<br />
PHC.<br />
• Pharmacist post filled as soon as<br />
possible or regularized deputation<br />
<strong>of</strong> pharmacist.<br />
• Required practical training to LT<br />
for RTI/STI.<br />
• Staff nurse also required training<br />
for RTI/ STI.<br />
CDHO/DDO<br />
1. Organized BEmoC & RTI Training to<br />
MO & staff nurse.<br />
2. Take permission from higher<br />
level for Pharmacist post fulfilled.<br />
3. Organized RTI/STI Practical<br />
training to LT.
Action Taken Report Form:-4<br />
During 2 nd onward QAG Meeting<br />
Name<br />
Of<br />
Facility<br />
What problems were<br />
identified in the last visit<br />
What decision had been<br />
taken in last time<br />
Who had taken<br />
action to sole<br />
the problem ?<br />
Has the problem<br />
been solved?<br />
Yes/No<br />
If No, Action<br />
required?<br />
Gangardi<br />
• Required BEmoC<br />
training for MO PHC.<br />
• Pharmacist post filled<br />
as soon as possible or<br />
regularized deputation<br />
<strong>of</strong> pharmacist.<br />
• Required practical<br />
training to LT for<br />
RTI/STI.<br />
1.Organized BEmoC &<br />
RTI Training to MO &<br />
staff nurse.<br />
2.Take permission from<br />
higher level for<br />
Pharmacist post<br />
fulfilled.<br />
3. Organized RTI/STI<br />
Practical training to LT.<br />
CDHO/DDO Yes …<br />
Jesabada<br />
• Required BEmoC<br />
training for MO PHC.<br />
• Pharmacist post<br />
filled as soon as<br />
possible or<br />
regularized deputation<br />
<strong>of</strong> pharmacist.<br />
• Required practical<br />
training to LT for<br />
RTI/STI.<br />
• Staff nurse also<br />
required training for<br />
RTI/ STI.<br />
1. Organized<br />
BEmoC &RTI Training<br />
to MO & staff nurse.<br />
2. Take permission<br />
from higher level for<br />
Pharmacist post<br />
fulfilled.<br />
3. Orgenized RTI/STI<br />
Practical training to LT.<br />
CDHO/DDO Yes …
N=72<br />
INPUT GRADING Base Line<br />
C<br />
38%<br />
A<br />
15%<br />
B<br />
47%<br />
N=462<br />
C<br />
27%<br />
INPUT GRADING 1st Visit<br />
D<br />
1%<br />
A<br />
18%<br />
A 76-100%<br />
B 51-75%<br />
C 26-50%<br />
D 0-25%<br />
B<br />
54%<br />
A 76-100%<br />
B 51-75%<br />
C 26-50%<br />
D 0-25%<br />
TOTAL (P+O) GRADING Base Line<br />
B<br />
0% C<br />
3%<br />
TOTAL (P+O) GRADING 1st Visit<br />
B<br />
0% C<br />
8%<br />
N=462<br />
N=72<br />
D<br />
97%<br />
A 76-100%<br />
B 51-75%<br />
C 26-50%<br />
D 0-25%<br />
D<br />
92% A 76-100%<br />
B 51-75%<br />
C 26-50%<br />
D 0-25%<br />
Note: Grade Based on the Quality Checklist
Amareli-BL<br />
Amareli-1st<br />
Surndranagar-BL<br />
Surndranagar-1st<br />
An<strong>and</strong>-BL<br />
An<strong>and</strong>-1st<br />
P'Mahal-BL<br />
P'Mahal-1st<br />
Patan-BL<br />
Patan-1st<br />
Ahmedabad-BL<br />
Ahmedabad-1st<br />
Rajkot-BL<br />
Rajkot-1st<br />
SK-BL<br />
SK-1st<br />
BK-BL<br />
BK-1st<br />
Junagadh-BL<br />
Junagadh-1st<br />
Baroda-BL<br />
Baroda-1st<br />
Porb<strong>and</strong>ar-BL<br />
Porb<strong>and</strong>ar-1st<br />
Narmada-BL<br />
Narmada-1st<br />
Valsad-BL<br />
Valsad-1st<br />
Kutch-BL<br />
Kutch-1st<br />
10<br />
13<br />
11<br />
11<br />
10<br />
13<br />
10<br />
8<br />
25<br />
25<br />
21<br />
21<br />
25<br />
38<br />
33<br />
33<br />
50<br />
50<br />
45<br />
50<br />
50<br />
50<br />
50<br />
45<br />
41<br />
38<br />
42<br />
56<br />
57<br />
38<br />
67<br />
70<br />
50<br />
100<br />
33<br />
80<br />
75<br />
50<br />
100<br />
100<br />
100<br />
100<br />
38<br />
71<br />
79<br />
40<br />
67<br />
54<br />
50<br />
50<br />
50<br />
50<br />
50<br />
50<br />
50<br />
50<br />
55<br />
38<br />
33<br />
11<br />
33<br />
33<br />
25<br />
25<br />
25<br />
15<br />
20<br />
10<br />
13<br />
7<br />
11<br />
5<br />
Quality Assessment – Base line & 1 st visit<br />
District wise Distribution <strong>of</strong> Total Scores <strong>of</strong> QA Inputs<br />
100%<br />
90%<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
Grade A Grade B Grade C Grade D
An<strong>and</strong>-BL<br />
An<strong>and</strong>-1st<br />
Amareli-BL<br />
Amareli-1st<br />
Junagadh-BL<br />
Junagadh-1st<br />
P'Mahal-BL<br />
P'Mahal-1st<br />
Porb<strong>and</strong>ar-BL<br />
Porb<strong>and</strong>ar-1st<br />
Patan-BL<br />
Patan-1st<br />
Surndranagar-BL<br />
Surndranagar-1st<br />
BK-BL<br />
BK-1st<br />
SK-BL<br />
SK-1st<br />
Baroda-BL<br />
Baroda-1st<br />
Ahmedabad-BL<br />
Ahmedabad-1st<br />
Kutch-BL<br />
Kutch-1st<br />
Narmada-BL<br />
Narmada-1st<br />
Rajkot-BL<br />
Rajkot-1st<br />
Valsad-BL<br />
Valsad-1st<br />
Quality Assessment – Base line & 1 st visit<br />
District wise Distribution <strong>of</strong> Total Scores <strong>of</strong> QA Process & Output<br />
100%<br />
90%<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
Grade A Grade B Grade c Grade D
25<br />
50<br />
25<br />
Surndranagar-BL<br />
15<br />
40<br />
45<br />
Surndranagar-1st<br />
100<br />
An<strong>and</strong>-BL<br />
25<br />
38<br />
38<br />
An<strong>and</strong>-1st<br />
50<br />
50<br />
P'Mahal-BL<br />
38<br />
38<br />
25<br />
P'Mahal-1st<br />
50<br />
50<br />
Rajkot-BL<br />
13<br />
75<br />
13<br />
Rajkot-1st<br />
100<br />
Junagadh-BL<br />
20<br />
70<br />
10<br />
Junagadh-1st<br />
100<br />
Porb<strong>and</strong>ar-BL<br />
50<br />
42<br />
8<br />
Porb<strong>and</strong>ar-1st<br />
100<br />
Narmada-BL<br />
50<br />
50<br />
Narmada-1st<br />
100<br />
Kutch-BL<br />
54<br />
41<br />
Kutch-1st<br />
Quality Assessment –District wise change<br />
100%<br />
90%<br />
80%<br />
70%<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
Grade A Grade B Grade C Grade D
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
GENERAL INDICATORS-1<br />
Field visit Field visit<br />
N = 72 (%) N=462 (%)<br />
PHC/CHC painted <strong>and</strong> looks clean (QB2b) 69 78<br />
A well marked signboard exhibiting clinic timings <strong>and</strong> all<br />
the services provided by this center – placed at the front<br />
entrance <strong>of</strong> facility (QB4)<br />
46 51<br />
Waiting area has benche(s) in the shade (QB1) 96 90<br />
Availability <strong>of</strong> drinking water for clients (B3a) 74 79<br />
Toilets for client have water <strong>and</strong> at least one is only for<br />
women (QB5)<br />
Labour room, exam room <strong>and</strong> OT is covered to ensure<br />
privacy (QC14)<br />
At least one ANM/Staff nurse available in 8 hourly duty<br />
round the clock (QA5)<br />
Any times in the previous quarter used PHC/CHC vehicle<br />
to refer EmOC cases to higher facility (QI5)<br />
44 50<br />
56 50<br />
65 96<br />
33 15
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
GENERAL INDICATORS-2<br />
Field visit Field visit<br />
N = 72 (%) N=462 (%)<br />
Only for CHC Functioning phone (public or private) available<br />
(QB11)<br />
44 72<br />
BP apparatus <strong>and</strong> stethoscope in working order (QC1) 83 90<br />
Sahli’s Heamoglobinometer in working condition to be used for<br />
measuring Hb with fresh N/10 HCL solution (QE2)<br />
79 82<br />
No cobwebs in the Facilities (QB3b) 83 66<br />
No Dust in mini OT or OT (QB3d) 42 38<br />
All occupied beds mattresses have rubber cover <strong>and</strong> sheet<br />
(QB3e)<br />
33 43<br />
Solid waste containers in each room (QB3c) 49 54<br />
Some form <strong>of</strong> emergency lighting available in working condition<br />
(QB6)<br />
A locked suggestion box in main waiting area – key with MO <strong>and</strong><br />
is opened on day <strong>of</strong> visit (QB7)<br />
49 53<br />
38 35<br />
Proper arrangements for segregation <strong>of</strong> waste (QB8) 54 64
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
MCH INPUT INDICATORS-1<br />
Field visit<br />
N = 72 (%)<br />
Field visit<br />
N=462 (%)<br />
ONLY for CHCs Gynecologist available on call 24 hrs<br />
(QA6a)<br />
15 23<br />
ONLY for CHCs Anesthetist on call 24 hrs (QA6b) 7 17<br />
A MO is trained in EmOC (QA1b) 24 37<br />
Oxygen cylinder with tubing <strong>and</strong> nasal masks available in<br />
working order (QC13)<br />
44 34<br />
Autoclave/sterilizer in working condition (QC3) 72 73<br />
Delivery kit contains at a minimum all <strong>of</strong> the following sterile<br />
articles: a) scissor/blades, b) cord ties/clamps <strong>and</strong> c) two cord<br />
clamping forceps (QC4)<br />
Sterile Episiotomy tray – containing a) scissors, b) needle<br />
holder, c) sterile needles <strong>and</strong> d) sterile self dissolving suture<br />
thread/chromic cat-gut (QC11)<br />
54 65<br />
47 58
Quality Assessment Field Visit Change During Base Line & 1 st<br />
Visit in <strong>Gujarat</strong>.<br />
MCH INPUT INDICATORS-2<br />
Field<br />
visit<br />
N = 72<br />
(%)<br />
Field visit<br />
N=462 (%)<br />
Both Normal Delivery & Newborn care guideline available at<br />
proper place (QD4 & QD5)<br />
IEC materials displayed at proper place for STI/ RTI, FP, EmOC<br />
(QD6)<br />
Pediatric resuscitation kit – pediatric self-inflating Ambu bag &<br />
Newborn mucus extractor or bulb syringe (QC8)<br />
28 46<br />
24 52<br />
14 31<br />
Infant weighing scales in working order (QC2) 78 85<br />
Room heater/ radiant baby warmer/Warm blankets (QC7) 18 25<br />
Inj Gentamycin (for Newborn Sepsis) (QE23) 81 89<br />
Sterile urinary catheter – 12 Fr. or smaller 14 Fr, 16 Fr (QC10) 54 46<br />
Cap. Nifidipine available (QE24) 33 20<br />
Inj. Magnesium sulphate for eclampsia available (QE27) 13 14<br />
Plasma exp<strong>and</strong>er –5 bottles e.g. heamaxcyl available (QE31) 6 12
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
MCH PROCESS & OUTPUT INDICATORS<br />
Field<br />
visit<br />
N = 72<br />
(%)<br />
≥ 60 ANC women in last 3 month (QG1) 46 34<br />
Any ANC women with BP greater than 130/90 in last 3months (QI1) 35 29<br />
Any ANC women receiving RPR test for syphilis in past 3 months (QG2) 0 2<br />
Field<br />
visit<br />
N=462<br />
(%)<br />
ANC cards available <strong>and</strong> filled (QF6) 57 68<br />
LR <strong>and</strong> conducted ≥ 10 deliveries in past 3 months (QB10, I2 & K9) 58 34<br />
Any delivery conducted in night (8 pm to 8 am). (QI3) 50 39<br />
Delivery records show normal deliveries <strong>and</strong> complications (QF7) 74 62<br />
No baby in ward was breastfed within 1/2 hour, nothing on cord, given OPV<br />
(QJ 1-4)<br />
Any low birth weight babies (birth weight less than 2.5 kg) that stayed at<br />
facility for 24hrs observation in the past 3 months (QI4)<br />
15 17<br />
43 24<br />
PNC for women <strong>and</strong>/or newborns within 6 weeks <strong>of</strong> delivery (QK11) 47 37
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
Field visit Field visit<br />
<strong>Family</strong> Planning indicator-1<br />
N = 72 (%) N=462 (%)<br />
IUD cards – available <strong>and</strong> filled for follow-up (QF3) 33<br />
50<br />
Sterilization forms available <strong>and</strong> filled for follow-up/refusal<br />
reasons (QF4)<br />
Any IUD users returned for removal after completion <strong>of</strong> 3<br />
yrs in the past 3 months (QK6)<br />
Any IUD acceptors screened for RTI/STI with a lab test in<br />
the past 3 months (QG4)<br />
46<br />
29<br />
0<br />
67<br />
42<br />
4<br />
FW Records show OCP usage <strong>and</strong> new accepted (QF2) 57<br />
67<br />
Any clients who have continued using oral Pills for more<br />
than 1 yr in the past 3 months (QK5)<br />
60<br />
62
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
Field visit Field visit<br />
<strong>Family</strong> Planning indicator-2<br />
N = 72 (%) N=462 (%)<br />
At least 3 temporary methods & EC pills ALL are available<br />
(QE12-15)<br />
3 laparoscopes or observed disinfected for ≥ 20 mins (QH1)<br />
Surgeon wore sterile gloves before each operation (QH9)<br />
Surgeon <strong>and</strong> nurses wore masks over nose <strong>and</strong> mouth during<br />
surgery (QH10)<br />
Pre-operative clinical screening for all clients (QH5)<br />
35<br />
Not<br />
Observed<br />
Not<br />
Observed<br />
Not<br />
Observed<br />
Not<br />
Observed<br />
62<br />
Not<br />
Observed<br />
Not<br />
Observed<br />
Not<br />
Observed<br />
Not<br />
Observed
Quality Assessment Field Visit Change During Base<br />
Line & 1 st Visit in <strong>Gujarat</strong>.<br />
Field visit Field visit<br />
RTIs/STIs indicator<br />
N = 72 (%) N=462 (%)<br />
MO <strong>and</strong> Lab tech. Both are trained for RTI/STI (QA1c &<br />
A4)<br />
An FHS/FHW/Staff nurse trained for pelvic examination &<br />
per speculum examination (QA2)<br />
LABORATORY Reagents like:- gram staining, KOH<br />
solution, pH test strips, RPR (Rapid plasma reagent) kits<br />
(for: syphilis) ALL are available (QE3-E6)<br />
18<br />
33<br />
0<br />
13<br />
37<br />
5<br />
Any RTI/STI Cases treated in past 3 months (QG5 & K2) 35 32<br />
≥ 25 RTI/STI cases were treated in last 3 months (QG5 &<br />
K2)<br />
Any partners <strong>of</strong> primary cases <strong>of</strong> STI/RTI also received<br />
treatment in the past 3 months (QG6 & K3)<br />
Any Urethral /Vaginal Swabs Tested for STI in past 3 month<br />
(QG8 & QK1)<br />
14<br />
14<br />
3<br />
11<br />
18<br />
7<br />
HIV Test kit available (QE11) 0 2
After this the process for accreditation <strong>of</strong> Our<br />
District Hospitals & Medical Colleges was started
Start but not the end……<br />
a new beginning
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