Safe Care, Saving Lives Quality Improvement Initiatives Serves as a Template for the Rajasthan Chirayu Program

Rajasthan is one of the four high mortality burden states in India, with a neonatal mortality rate of thirty two deaths per one thousand live births. More than fifty seven thousand babies die every year in the state – that is about six babies dying every hour. More than two thirds die within the first seven days of birth. In addition to these depressing numbers, more than four thousand mothers die annually from pregnancy related complications.

To reverse this trend, the Rajasthan Department of Health and Family Welfare launched an ambitious new initiative called the Chirayu Program. The goal of Chirayu is to reduce neonatal mortality in eight high burden districts, namely Udaipur, Dholpur, Sawai-Madhopur, Barmer, Sirohi, Karauli, Jalore, and Rajsamand. The Boston Consulting Group, along with ACCESS Health International as its knowledge partner, is supporting the Government of Rajasthan in revitalizing its primary care system by fixing gaps in human resources and infrastructure and providing technical support to the Government of Rajasthan to address the high burden of neonatal deaths. The work is taking place in two hundred and ninety five primary health centres.

The Government of Rajasthan organized a review meeting cum workshop of the Chirayu Program in Jaipur in August, 2017. The Special Newborn Care Unit nodal officers and district level program officers from the eight Chirayu districts and the state level program officers participated in the daylong meeting. The meeting was chaired by Ms. Veena Gupta, Principal Secretary, Department of Health and Family Welfare, Government of Rajasthan, and Mr. Naveen Jain, Mission Director, National Health Mission Rajasthan. Dr. P. K. Prabhakar Deputy Commissioner Child Health, Ministry of Health and Family Welfare and senior paediatricians from Delhi also participated in the meeting. Dr. Ajitkumar Sudke, Director of Quality and Process Improvement at ACCESS Health International and head of the Safe Care, Saving Lives program was invited to share his experience of implementing Sare Care, Saving Lives in Telangana and Andhra Pradesh.

Dr. Sudke spoke about facility level engagement and ownership in order to bring about true change, using data for improvement, and sharing successes and failures through learning sessions. Leadership engagement and ownership at the facility, district and state level as well as willingness to change and improve are key drivers for any quality improvement project.  Safe Care, Saving Lives program is unique in that it is one of the only large scale quality improvement programs focused on newborn care. It covers all Special Newborn Care Units in the public sector in the two states, including Neonatal Intensive Care Units in the private sector. The program is driven jointly by the publicly funded health insurance program and the office of the Commissioner, Health and Family Welfare. The program covered more than eighty percent of the facility based newborn care in the two states.

Dr. Sudke stressed the importance of working directly in labor rooms as a majority of neonatal deaths take place at the time of delivery. He shared details of the development of a package of potentially better practices for labor room staff to adopt and implement, the components of the Institute for Healthcare Improvement’s model for improvement, developing driver diagrams to address the common causes of mortality, identifying change ideas and testing them for impact, meticulous data collection, and analysis for tracking improvement. Dr. Sudke shared how Safe Care, Saving Lives applies these approaches and the successes that have resulted from this quality improvement approach, including reductions in sepsis, birth asphyxia, and mortality.

To throw more light on the exact methodology Safe Care, Saving Lives uses, Dr. Sudke shared an example from District Hospital Khammam in Telangana. Khammam hospital  embarked on its quality improvement journey by implementing eight potentially better practices. These efforts resulted in remarkable outcomes. Sepsis cases were reduced by more than sixty five percent. The use of an improved aseptic non touch technique nearly tripled. Compliance to better hand hygiene also improved significantly.

Dr. Sudke highlighted the importance of facility level governance measures to implement quality improvement as a critical component for sustainability. He also noted the essential importance of rigorously tracking data to assess compliance with better practices in order to improve outcomes.

ACCESS Health is developing a mobile application for Quality Improvement which will help facilities in easy data collection and analysis. Mr. Naveen Gupta, Mission Director thanked Dr. Sudke for sharing the highlights of the Safe Care, Saving Lives Program and urged the Chirayu district teams to study the model in detail and try to implement the best practices from the Safe Care, Saving Lives program.