National Convention on Quality in Public Health – 03-04 November 2014

Background: - National convention on Quality in Public Health was organized by Ministry of Health and Family welfare with support from Quality Improvement division of National Health System Resource Centre on 3rd and 4th of November at NDMC convention Centre, Sansad Marg, Connaught Place New Delhi.

In continuation of the Operational Guidelines for the district hospitals, the Quality Assurance Guidelines for Primary Health Centers & Community Health Centers were rereleased on this occasion.

The main objectives of this convention were

• To provide a common platform at National Level for public health practitioners, service providers and quality professionals working towards improving Quality of services in public health facilities.

• To create pool of best practices and interventions for Public health facilities to improve the quality of services.

• To disseminate Policies and Guidelines related to Quality including Standards for Primary Health Centers.

• To facilitate consultation within different stakeholders to chalk out state specific road map and action plan for Quality Assurance.

Inaugural Session

Hon’ble Union Health Minister, Dr. Harshvardhan, inaugurated the convention. The inaugural session comprised of Dr. Jagdish Prasad (Director General Health Services), Mr. Lov Verma (Health Secretary), Mr.CK Mishra (Additional Secretary & Mission director NHM), Mr.Manoj Jhalani, Joint Secretary (Policy) and Dr. Sanjiv Kumar (Executive Director National Health System Resource Centre). Principal Secretaries, Mission Directors, Programme Officers, and Quality Practitioners across the states & Union territories made their active participation. Technical support Units, Development partners, Educational Institutes, Private Hospitals & various Medical Colleges were also a part of the convention.

Plenary 1:- Cross Learning in Quality

Mr. C. K. Mishra, Additional secretary & Mission Director National Health Mission, chaired Plenary 1.The Plenary 1 comprised of Key speakers from WHO as well as NICE international UK .The session began with an eminent speaker Mr. Manoj Jhalani, Joint secretary policy who gave “Overview of the National Quality Assurance Standards. While delivering this lecture he talked about the Perspective of Quality from patients and service provide view. He highlighted the importance of Quality in Public health facilities and explained the applicability of National Quality Assurance Standards for public health facilities over NABH and ISO .His talk briefed the participants on the structure, Process and outcome of National Quality Assurance Standards.

Plenary 1 comprised of two sessions from WHO SEARO. Dr.Martin Weber who is working in the capacity of Regional Advisor at WHO SEARO office India delivered a talk on “The Best Practices in Quality Assurance – Learning from the SEARO countries.Dr. Martin briefed on the WHO /SEARO framework of Quality. He discussed a study carried out for Assessing Maternal health services in Indonesia at Hospitals, Healthcare Centers and Midwifery clinics and highlighted the score of quality in Antenatal, Normal and Post Natal care .He discussed the findings of the study in context of delivering Quality and also suggested ways and means to overcome those issues. Summarizing his talk the message delivered by him was Quality of Care is the major cause of morbidity and mortality. Dr. Sunil Senanayake, Regional Advisor at WHO SEARO office India, delivered another topic of concern “Importance of Quality and Safety in Healthcare”. During his talk he talked about PATIENT SAFETY: Serious global public health issue. He discussed the WHO Patient safety programme and highlighted the regional challenges in patient safety. He also discussed a WHO report of Hospital Acquired Infection from developing countries.

Dr. R. D. Ravindran, Chairman, Aravind Eye care system shared his view on “Quality in Healthcare” Aravind Eye care model. During his talked he discussed the Quality Paradigm, whichfocused on six aims of quality Equity, timeliness, effectiveness, efficiency, patient centeredness and safety. He quoted various examples from Aravind Eye Care on these six principles of Quality. He highlighted the importance of teamwork to sustain and maintain Quality.

Dr. Abha Mehndiratt, representative of NICE international, delivered a talk on Quality & Outcomes framework in UK NHS: Linking NICE Quality Standards to payment. She gave an overview of Quality of outcome framework in UK.She explained the three domains of QOF: - Clinical which comprise of 69 indicator ,Public Health comprising of 7 indicators and Public Health additional services comprising of 5 indicators. She briefed on Key principles of QOC indicators, its applicability and improved outcomes.

Plenary 2: Operationalizing Quality Assurance –

Mr. Manoj Jhalani, Joint Secretary Policy, chaired Plenary 2

The Plenary 2 comprised of four sessions .The first session “Operationalizing Quality Assurance institutional framework under NHM” was covered by Dr. J. N. Srivastava who is leading the Quality Improvement Division as an Advisor in National Health System Resource Centre. This Presentation basically highlighted the steps for National Quality Assurance Standards. He threw a light on the reconstitution of state as well as district quality assurance committees, Operationalizing of state as well as district quality assurance committees, selection process of facilities, Assessment and gap closure activities and the certification process.

Dr. Bulbul Sood country director of Jhpiego, made a presentation on “Quality of care for improved RMNCH+A outcomes”. During her presentation she highlighted Context and need for focusing on Quality, Determinants and Drivers of Quality and Strategies and Interventions relevant to India for RMNCH+ A approach.

Dr. M Mariappan, Chairperson, Center of Hospital Administration, Tata Institute of Social Sciences, Mumbai delivered a talk on the Quality Assessment Report of 12 District Hospitals. He discussed the standards, objectives, methodology and analysis of the baselineline assessment. He discussed the scoring of various district hospitals with key findings, challenges and way forward.

Dr. Nikhil Prakash working as a senior consultant Quality improvement with National Health System Resource Centre addressed the last session of the plenary. He discussed the importance of quality with the deming cycle Plan, Do, Check &Act .Under Plan he discussed about the Quality Team its meetings, Quality Objective, policy and preparation of time bound action plan for quality objectives. He stressed on the importance of formulating Standard operating procedures, conducting trainings and carrying out patient satisfaction surveys. He laid down the importance of carrying audits as an activity of check .He also discussed various tools of quality improvement like brainstorming, cause and effect diagrams, pareto and control charts.

Across 20 states presented their best Practices in QUALITY IMPROVEMENT. The representatives from various states presented their posters and shared their experiences with participants on their various moves and initiations in Quality Panel.

Panel Discussion- Learning on Quality from states

Last session of the day was a panel discussion on learning’s of States on improving quality of services. The Panel Discussion was chaired by Dr. Rakesh Kumar, Joint Secretary RCH and Co-chaired by Prof.J. K. Das, Director National Institute of Health and Family Welfare. The Panelist was Quality Practitioners from various states:-

Dr. Roopa Mishra: - Mission Director NM Orissa shared her views on “operationalizing Quality Assurance Programme in Odisha. She shared the focus area in Odisha is RMNCH+ A services. She also discussed the Quality initiatives taken by Odisha for critical care units.

Dr. Sanjiv Sanyal representative from NHM west Bengal made a presentation on “Quality Assurance in High case Load Facilities”. He discussed the implementation of ISO in various facilities and made a comparison “before and after implementation of ISO”.He also highlighted some best practises adopted in the hospitals for Quality.

Dr. N Vasantha Kumar, Mission Director NHM Delhi state shared his views on ensuring quality in Primary Urban Health centers. He discussed about the Public Health Standards developed for Primary urban health centers. He gave a briefing on the work done on these guidelines.

Dr. K Kolandaswamy Director of Public Health and Preventive Medicine Tamil Nadu discussed “Measuring quality of care at Primary Health Centres”. He discussed about the various approaches of Quality adopted by Tamil Nadu like NABH and ISO .He discussed the Quality policy of the state.

Dr. JL Meena State Quality Assurance Medical officer, Gujarat. He discussed about the quality objective of the state. He highlighted the quality improvement programme in Gujarat, which showed the implementation of NABH in various hospitals,CHC and PHC.

Day 2

The second day was started with Key-note Address by DrRakesh Kumar Joint Secretary (RCH) with a important topic in terms of “Moving beyond numbers: Conquering the last frontier in Public Health”. He given the emphasis on India’s progress on key indicators, what is quality of care and quality improvement, Framework of QI and its theory, key Quality Initiatives under NHM and conclusive point which was handful for delegates.

Plenary 3:- Quality in RMNCH+A Services

Plenary 3 was chaired by DrRakesh Kumar Joint Secretary (RCH)

Plenary 3 comprised of eminent speakers from Ministry of Health and Family Welfare and a veteran Quality Expert. The session began with one of the eminent speaker Dr Dinesh Baswal DC (MH) who briefed “Ensuring Quality in Maternal Health Services”. He emphasis on every aspects of Quality Concerning to Maternal Health and also briefed about MNH tool kit.

Second session of Plenary 3 was taken by DC (I/C CH) Dr Ajay Khera and shared his view on “Quality Issues in Child Health Programme”. He has given overview of Quality issue in SNCU, NBCC and NBSU. He concluded his presentation with a great note, Quality is never an accident, it is always the result of high intention, sincere effort, intelligent direction and skillful execution, it represents the wide choice of many alternatives.

The preceding session was taken by DC (I/C FP) Dr S K Sikdar. He delivered a talk on “Quality issue in Family Planning Services”. He covered all the concerning points of Family Planning. He emphasis on input, process and outcome and highlighted about the Quality Assurance Committee.

Dr. J N Sahay Quality Expert delivered his view on “Sustaining Quality in Public Health”. He shared his experience from every corner of Quality, which was handful for implementation, and Sustaining Quality. He discussed about the framework of Quality.

Group work – Road Map for Quality

Post tea all the States & UT presented the Road Map for Quality Assurance in the stipulated time period.

State / UT were overview their respective Road Map for Quality Assurance in following five main headings:

1. Institutional Frame work

2. Training and Capacity Building

3. Measuring Quality

4. Facility level Quality Improvement

5. Certification

Finally the National convention of Quality in Public Health was concluded with flyingcolors with vote of thanks to the chair by Mr. Manoj Jhalani, Joint Secretary, Policy.