1. Session 2 Introduction to QA Principles & Operational Manual

2. Guiding Principles of Developing QA Manual Simple and easy to comprehend and use Minimum load on programme managers-builds on existing supervisory functions Flexible to include new elements of services Built on principles of facilitative supervision Developed on the basis of prior piloting experiences in other states and specifically Gujarat where it has been scaled up to cover the entire state Above all, the larger framework of RCH II M&E System has been kept in mind

3. Quality of Care & Quality Assurance Quality of Care Attributes of a service program that reflect adherence to professional standards, in a congenial service environment and satisfaction of the part of user (UNFPA technical report 1999) Quality Assurance Mechanism/process that contribute to defining, designing, assessing, monitoring and improving quality of health care Two Components  Quality Assessment  Quality Improvement

4. Operationalizing QA in a district QA Approach-Elements of Quality Institutional Arrangements QA Assessment Methodology QA Tools/Checklists

5. QA Approach-Elements of Quality Identifies nine elements for measuring quality of care adapted from UNFPA’s technical report entitled “ Planning Population and Development Projects” with a focus on decentralization and quality of care  Five are generic elements Service environment Client provider interaction Informed decision making Integration of services Woman’s participation  Four are service specific elements Access to services Equipment and supplies Professional standards and technical competence Continuity of care

6. Elements of Quality-Generic Service environment – infrastructure, basic amenities, clients comfort, privacy etc. Client provider interaction - nature of provider – client relationship and information exchanged between them Informed decision-making - availability of relevant information and service procedures that facilitate informed choice by client Integration of services - linkage of services and health institutions Women’s participation in management –Women participation in planning, implementation and monitoring of RH services

7. Elements of Quality-Specific Access to services – Location, distance, timing of facility, affordability in terms of travel cost, lost wages etc. Equipment and supplies - Equipment of standard specifications are available? In working order? Sufficient supplies available? Professional standards and technical competence – providers competent? Service guidelines/protocols available? Service standards established? Continuity of care – clients follow up regular and effective? Side effects/complications managed? MIS designed and maintained?

8. RCH Quality Framework for Assessment RCH facility based Services to be assessed INPUTSPROCESSOUTPUTS Family Planning Building Infra- structure Equipment Personnel- training Supplies Clinic-wide procedures e.g.- Schedules, Hygiene, Asepsis Technical competence Client Provider interaction FP method mix Complications Follow-up Maternity Care ANC/PNC Norms at Deliveries Complications managed RTI/STI & HIV -VCT Lab tests Case treatment Follow-up Child Health Cold chain maintenance Safe injection practices AD syringe use and disposal

9. Thank you