Jhpiego India, New Delhi, India.
Department of Health Sciences/Global Health, University of Groningen/University Medical Center Groningen, Groningen, The Netherlands.
PLoS One. 2020 Dec 23;15(12):e0244088. doi: 10.1371/journal.pone.0244088. eCollection 2020.
In response to longstanding concerns around the quality of female sterilization services provided at public health facilities in India, the Government of India issued standards and quality assurance guidelines for female sterilization services in 2014. However, implementation remains a challenge. The Maternal and Child Survival Program rolled out a package of competency-based trainings, periodic mentoring, and easy-to-use job aids in parts of five states to increase service providers' adherence to key practices identified in the guidelines.
The study employed a before-and-after quasi-experimental design with a matched comparison arm to examine the effect of the intervention on provider practices in two states: Odisha and Chhattisgarh. Direct observations of female sterilization services were conducted in selected public health facilities, using a checklist of 30 key practices, at two points in time. Changes in adherence to key practices from baseline to endline were compared at 12 intervention and 12 comparison facilities using a difference in difference analysis.
Several key practices were well-established prior to the intervention, with adherence levels over 90% at baseline, including hemoglobin and urine testing, use of sterile surgical gloves and instruments, and recommended surgical technique. However, adherence to many other practices was extremely low at baseline. The program significantly increased adherence to nine practices, including those related to ascertaining client's medical eligibility, client-provider interaction, the consent process, and post-operative care. The greatest improvement was observed in the provision of written instructions for clients prior to discharge. At endline, however, adherence remained below 50% for 14 practices.
Low adherence to key practices at baseline confirmed the need for quality improvement interventions in female sterilization services. While the intervention improved adherence to certain practices around admission and post-operative care, inadequate human resources and infrastructure, among other factors, may have blunted the impact of the intervention.
针对印度公共卫生机构提供的女性绝育服务质量长期存在的担忧，印度政府于 2014 年发布了女性绝育服务的标准和质量保证指南。然而，实施仍然是一个挑战。母婴生存项目在五个邦的部分地区推出了一整套基于能力的培训、定期指导和易于使用的工作辅助工具，以提高服务提供者对指南中确定的关键实践的遵守程度。
该研究采用了前后准实验设计，并结合了一个匹配的对照组，以检查该干预措施对两个邦（奥里萨邦和恰蒂斯加尔邦）服务提供者实践的影响。在两个时间点，使用 30 项关键实践检查表，对选定的公共卫生设施中的女性绝育服务进行直接观察。采用差异中的差异分析，比较了 12 个干预设施和 12 个对照设施在基线和终点时对关键实践的遵守情况的变化。
在干预之前，一些关键实践已经很好地建立起来，在基线时的遵守率超过 90%，包括血红蛋白和尿液检测、使用无菌手术手套和器械以及推荐的手术技术。然而，许多其他实践在基线时的遵守率极低。该项目显著提高了对 9 项实践的遵守率，包括与确定客户医疗资格、客户与提供者的互动、同意过程和术后护理有关的实践。最大的改进是在出院前为客户提供书面指示。然而，在终点时，仍有 14 项实践的遵守率低于 50%。
基线时关键实践的低遵守率证实了需要对女性绝育服务进行质量改进干预。虽然干预措施提高了对入院和术后护理等某些实践的遵守率，但人力资源和基础设施不足等其他因素可能削弱了干预措施的影响。
