Technical Support for National and Subnational Capacity Building to Improve Leadership and Management of District Quality Improvement Programs for Maternal and Newborn Care in Bangladesh

The Challenge

Moving away from a reliance on international partners for support for QI programs and institutionalizing QI support within a country’s existing systems is the primary challenge.

Overview and Objectives

UNICEF is one of the lead partners supporting the Ministry of Health and Family Welfare (MOH&FW) build institutional capacity for a quality improvement (QI) system at national and sub-national levels.

URC provided technical assistance to UNICEF, the MOH&FW, and a local partner, the National Institute of Preventive and Social Medicine (NIPSOM) to scale up the use of QI methods in new districts. QI methods twere used to improve the quality of care provided to mothers, newborns, and children in selected health facilities. NIPSOM is being developed as a national hub for QI learning.

• Build QI capacity at the national level through leadership and management for the district QI system
• Strengthen district QI management systems with district managers leading the QI implementation at facilities
• Adapt data systems to support and strengthen QI monitoring and knowledge management
• Support district and facility teams implement and monitor QI plans
• Establish peer-to-peer learning systems
• Help develop a QI coaching and mentoring system
• Develop capacity of national and regional institutes to operationalize, manage, and sustain a QI learning system in country

Achievements

• Scale up QI learning facilities from one district and five facilities in 2016 to 15 districts and 90 facilities in 2020
• Carry out QI program management capacity-building national workshops in seven districts and 23 facilities
• Hold on-going peer-to-peer learning facilitation and QI capacity-building webinars
• Begin implementation of the 4-step Point of Care Quality Improvement (POCQI) approach for maternal and newborn health (MNH) services in seven districts. URC pioneered the POCQI approach under the USAID ASSIST Project in India and South Asia and published guidance manuals with WHO’s South East Asia regional office.
• Train approximately 1,000 health care providers in QI
• Increase the number of health facilities measuring newborn temperatures within one to two hours after birth from 68% to 100% in seven MNH quality of care learning districts
• Decrease the percent of newborns becoming hypothermic one to two hours after birth from 33% to 5% in one year
• Contribute to a 10% reduction in perinatal death rates in 28 health facilities across seven MNH QoC learning districts
• Increase percent of handwashing practices among patients from 34% to 96%
• Decrease the average duration of waiting time for antenatal and postnatal services from 3 hours 47 minutes to 1 hour 13 minutes
• Reduce by 67% number of labor cases referred out from the Upazila Health Complex in Ulipur
• Labor admissions identified as high risk using partograph increased by 14% in 28 health facilities across seven MNH quality of care learning districts (January 2019 – August 2020)