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In the last few years, Bihar has shown improvement on some important family health indicators, driven by cumulative eorts of the national and the state government to strengthen the state public health system’s quality. The latest data released by the fourth National Family Health Survey (NFHS-4), 2015–2016, shows that the share of women availing institutional births and receiving pre- and postnatal care has gone up substantially in the state. The fertility rate in Bihar has also come down from 4 children per woman in NHFS-3 to 3.4 in NHFS-4. However, Bihar still finds itself encumbered by daunting public health challenges on multiple fronts. The state continues to struggle on the nutritional status of children, with a huge share of underweight and stunted children. Further, over two-thirds of the children are anaemic.
Commitment to Improved Quality
QUALITY ASSURANCE AND THE ROLE OF BTAST
However, in March 2014, GoI rolled out protocols and guidelines for NQAS with the intention of standardising quality assurance in the public sector health system in the country. As part of the quality assurance process, quality assurance committees or quality teams have been instituted at state level, district level, and at each facility level. The process entails a two-pronged approach:
This approach is integrated into the public health system’s natural functioning, in conformity with the quality assurance cells at state, district, and regional level. State government departments were encouraged to include NQAS related quality assurance activities in annual Programme Implementation Plans (PIPs). The Government of Bihar has been an early adopter of NQAS, having stepped up its quality assurance objectives from FFHI to NQAS certication for which SHSB developed a quality assurance road map with support from BTAST.
Bihar initiated some innovations in the NQAS implementation process to meet local needs, while keeping the overall process in line with central government guidelines. For example, while the central guidelines do not have any provision for regional quality assurance committees, the state BTAST Intervention Districts Non-Intervention Districts health department has constituted regional quality assurance committees in nine regions following approval from the central government. The main rationale behind the constitution of regional committees is the ease of monitoring through regional channels. This provision, it is hoped, would enable the process to be better managed and the regional stakeholders to be more responsible. BTAST has been helping SHSB at the eld level as well as at the strategic level.
It has been helping with building quality assurance teams at dierent levels, handholding quality assurance committee members at the facility level in understanding their roles and responsibilities in the quality assurance process, as ell as creating a roadmap for NQAS and FFHI compliance. The Quality Assurance Roadmap, for 2014-16, has three focus areas: strengthening quality assurance mechanisms and structures across levels; upgrading facilities to full quality related criteria as per the NQAS framework and certication; and training and capacity building of service providers. Whereas most states are strengthening facilities on their own, Bihar has employed Quality Consultants through BTAST at the facility and district level. BTAST’s technical experts supported SHSB at the state level. Some of the specic components of work have included:
Apart from the crucial issue of sustainability, other barriers to quality of care became apparent. Manpower shortage, especially of nursing staff and specialists; lack of training; persistent infrastructural issues; and shortage of emergency medicines and instruments and labour room essentials are the key gaps in some of the facilities. Along with addressing these longstanding issues, any sustainable solution for ensuring continued delivery of quality care must also address the critical need for regular monitoring and corrective action and securing the buy-in and motivation of healthcare staff.
By: Ziyaur Rahman ProfileResourcesReport error
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