Many would assume that the 45,000 mothers dying in India
every year during childbirth is
a result of complications that are difficult to manage. It should be rather
surprising that these deaths are mostly preventable. In fact, one of the main
reasons for losing lives is often due to sub-standard and inconsistent quality
of care.
Our entire maternal
health care community is aware of this. And yet, improving the quality
of maternal health services has been a tough challenge in India, largely due to
insufficient tools and incentives for providers to change.
In recent years, considerable efforts to improve the quality
of institutional care during the antenatal, delivery and postpartum periods
have favored public health care facilities, largely excluding private ones.
This has been the case despite the fact that private providers in India account
for up to 30% of institutional deliveries in rural areas and up to 52.5% of
institutional deliveries in urban areas, and despite evidence suggesting that
quality of care is an issue in both sectors. Many such facilities, even those
that have been in business for 5 to 10 years and even longer, have been found
not to be following recognized, evidence-based quality standards of care in
their labor and delivery wards. They do not have the necessary emergency
protocols in place to prevent complications.
These challenges persist due to a widespread lack of
technical resources, insufficient training and other opportunities for nurses
and paramedics to update their skills and knowledge (leading to continued use
of outdated, ineffective and sometimes harmful practices); weak incentives for
private maternity facilities to invest in quality improvement because efforts
typically do not immediately translate into an increased client base; and
limited capacity (if not total absence) of systems to measure and monitor the
quality of their services.
Greater efforts must be made to bridge the gap between
research-supported knowledge and clinical practice. What we need is a large
scale streamlined quality improvement initiative, offering a practical and
compelling way for private health care facilities to improve their capacities
for managing care during labor, delivery and the immediate postpartum period,
when risks for life threatening complications are the highestAn intervention which offers all of the above is an
important step forward for maternal health in India. Read more here
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