Between 2012-2014, NICE International (iDSI), the Government of Kerala and the Kerala Federation of Obstetricians and Gynaecologists (KFOG) worked in partnership to develop and implement quality standards for maternal mortality. Future work under iDSI will continue to explore opportunities for development of evidence-based guidance and policies through established links with local and national level organisations.
See below for latest news, further background and a timeline of activity for the Kerala work.
Kerala Quality Standards incorporated into nurse training
Our earlier engagement in India supported the Government of Kerala toEmergency Obstetric Care and Advanced Life Support training (EmOCaLS) training for nursing book in Kerala. This demonstrates the practical contribution that well-developed and locally owned Quality Standards can make to improving staff training, their skills and their confidence in providing effective, quality care for women in hospitals.
Learning from the Kerala experience developing and implementing Quality Standards to improve maternal care in maternity hospitals
Two teams from Odisha and Bihar travelled to Kerala to visit quality initiatives and attended the monthly review meeting for the Quality Standard pilot implementation in Trivandrum at the invitation of the National Health Mission (NHM) in Kerala and the Kerala Federation of Obstetricians and Gynaecologists (KFOG). The aim was to learn from the Kerala experience with developing and implementing Quality Standards to improve maternal care in maternity hospitals, to reflect on their applicability to Odisha and Bihar and to outline a framework for reducing maternal mortality in the context of existing initiatives. The Odisha Team was led by Ms Roopa Mishra, Mission Director of the NHM.
Reflecting on their experience, the teams highlighted how the strong partnership between the Government of Kerala, the KFOG and NICE International has led to developing robust and credible Quality standards on Post Partum Haemmorhage and improved the management of complications in pregnancy to help decrease maternal mortality. Strengthening the Maternal Death Review Committees was seen as a priority in Odisha and Bihar. Following the Kerala model Odisha is planning to increase the involvement of professionals in obstetrics and Gynaecology in the Confidential Maternal Death Review. In Bihar there are plans to roll out the Safe Birthing Checklist in consultation with the State Health Society Bihar (SHSB) of the Department of Health.
Delegates underlined the opportunity for strengthened and continued Technical Assistance from DFID on these initiatives beyond 2015, including local team support and support from agencies like NICE International in strengthening Maternal and child death review processes and focussing on protocol development, analysis, research and documentation.
The Royal College of Obstetricians and Gynaecologists featured the Kerala project on developing Quality Standards to improve hospital maternal care in its March international newsletter. NICE International is providing technical support on the project, working with the Government of Kerala and the Kerala Federation of Obstetricians and Gynaecologists.
Quality standard pilot in Kerala
Francoise Cluzeau attended the fifth monthly review meeting of the pilot implementation of the Quality Standard (QS)for improving maternal health in maternity hospital in Trivandrum, kerala. The meeting was attended by the newly appointed Principal Health Secretary for Kerala, Dr Elangovan, all 8 pilot hospitals, and the Kerala Federation of Obstetricians & Gynaecologists. The Director of the National Rural Health Mission in Kerala, Dr Beena chaired the meeting. As well as reporting their monthly maternity data hospitals discussed their experience so far, highlighting areas for improvement and how these can be resolved.
Francoise Cluzeau also visited two pilot hospitals: Community Health Center, Kanyakulangara and Women and Children Hospital, Trivandrum. The introduction of the QS has led to improvement in delivery equipment available in labour wards, in observation of women post-delivery and recording of information in the labour register. Maternity staff were enthusiastic about the changes in the practice and progress made in the past five months. Discussions were held about how quality improvement activities such as regular audit could be introduced with the staff in the hospitals based on the QS data. The pilot phase continues until the 31 March 2014.
Find out more information on the quality standard pilot in this news story: Guidelines bring PPH deaths under control, The Hindu, 16 October 2013
Scoping visit to Odisha
In a scoping visit to Odisha, India Francoise Cluzeau met Dr Roopa Mishra, the Mission Director of the National Rural Health Mission (NRHM) to discuss how NICE International could provide technical Assistance to strengthen current initiatives on improving maternal care in Odisha. Meetings were held with directors of NRHM Departments, heads of non-government agencies and the local Technical Management Support Team. The scoping tour included a visit at the District Headquarter Hospital in Puri and the maternity services. Odisha is one of the three priority states in India for the Department for International Development (DFID) and a target for building local health capacity to help improve health care delivery, especially in maternal and child health. It is envisaged that the Odisha team will be able to learn from the initial experience in Kerala of developing and implementing the Quality Standard on Maternal care an initiative funded through the DFID Health Partnership Scheme and for which NI is providing technical support.
Implementing the quality standard on maternity care
NICE International visited two hospitals in Trivandrum, Kerala where the recently published quality standard on maternal care (1st Edition) will be piloted. From the 1 April 2013 eight hospitals (6 public and 2 private) will be implementing the standards on post-partum haemorrhage and hypertensive disorders in pregnancy on a trial basis. This initiative is managed by the National Rural Health Mission under the leadership of the Principal Secretary (Health) of the Government of Kerala, Rajeev Sadanandan and in partnership with the Kerala Federation of Obstetricians and Gynaecologists. NICE International has provided technical support to the Kerala team throughout the project.
Quality Standard Working Group finalise quality standards
NICE International met with the Quality Standard Working Group in Trivandrum India to finalise quality standards aimed at improving the quality of care mothers receive in hospital to help reduce maternal mortality. Under the leadership of the Principal Secretary for Health & Family Welfare and guided by the Kerala Federation of Obstetricians & Gynaecologists (KFOG) the multidisciplinary group agreed statements of good practice that will be piloted in 8 hospitals (public and private) from 1 April 2013.
- The Hindu, December 2012, Guidelines evolved to reduce MMR
Workshops on maternal mortality in conjunction with the government of Kerala, India.
In the summer of 2012, NICE International, under the auspices of the Government of Kerala, and with additional funding support from the Joint Learning Network, the UK’s Department for International Development and the Wellcome Trust, organised, in collaboration with the Kerala Federation of Obstetricians and Gyanecologists, two workshops aimed at reducing maternal death rates in the State of Kerala. Under the leadership of the Principal Secretary of the State and senior clinicians, and drawing on Kerala’s Maternal Death Audit, State and Government Surveys, as well as the State’s Clinical Guidelines on post-partum care, and the WHO, Royal College of Obstetricians and Gynaecologists and NICE guidelines, we have collaboratively produced the first Quality Statement on active management of third stage of labour. The Statement is accompanied by measurable indicators and will be finalised and taken forward (in terms of ensuring measurement, regular reporting and impact measurement) by a multidisciplinary team of Kerala experts, including the Principal Secretary, the Director of the State’s Rural Health Mission, the Directors of Health Services and of Education, as well as leading clinicians, nurses and administrators. Whilst Kerala has the lowest maternal mortality across India and has achieved the relevant MDGs, there is commitment by the professional community and by government to make further improvements.
NICE International, with support from NHS consultants and UK academics, as well as partners such as ACCESS, is hoping to work alongside the Government of Kerala over the next 3 years, with a view to taking this process of building implementable and measurable quality standards, to other, poorer Indian States, in collaboration with the Kerala multidisciplinary group and with support from DFID India.
Preparatory meeting on developing measures for reducing maternal mortality in Kerala
As part of an on-going engagement with the Government of Kerala, NICE International held a two-day meeting in Trivandrum together with the Health and Family Welfare Department, to develop measures for reducing maternal mortality in Kerala. This preparatory meeting will be followed by multi stakeholder workshop in August. This work is sponsored by the Department for International Development (DFID), the Joint Learning Network (JLN) and the Wellcome Trust.