Assessment and implementation of quality assurance in labour rooms in different tiers of health facilities of west bengal, india

Background: Quality of care at the health facilities during childbirth remains a key concern. Enhanced quality could have the utmost dividend in saving maternal and newborn lives.
Objective: The objective of this study was to assess quality assurance measures in the labor rooms of different tiers of public health facilities West Bengal.
Methods: Labor room quality assurance intervention was implemented in selected Basic Emergency Obstetric and Neonatal Care (BEmONC) and Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) facilities. The facilities was assessed using labor room quality assurance checklist developed by the Ministry of Health and Family Welfare. The critical gaps affecting service delivery were identified, and a list of priority actions for quality improvement was developed. An intervention model was rolled out in consultation with the Maternal Health Division and the State Quality Assurance Division, West Bengal and UNICEF focusing on each area of concern of quality assurance. Initial assessment was done from January 2018 to April 2018. The interventions were implemented from August 2018 to July 2019 in the selected facilities after which a final assessment was conducted. Results: Assessment of labor room (BEmOC and CEmOC) was conducted in 105 facilities. The activities toward implementation of the Quality assurance model continued for almost 12 months after which a repeat assessment was done to evaluate the improvements. The results demonstrated a definite improvement in quality assurance scores in most of the facilities with Presidency division little better than Jalpaiguri division. During the intervention period, the scores for Outcome were increased by 20 points in Jalpaiguri division (from 38.0 to 58.1), 19 points in Presidency division (from 45.4 to 64.4) and 18 points in Barddhaman division (from 36.9 to 54.5). The highest gain in scores was observed in quality management component in Presidency division (from 15.4 to 43.0). Conclusion: It is possible to further strengthening of quality assurance output within public health system with sustained efforts and commitment.