ABSTRACT
Objective: To compare the impact of quality improvement (QI)approaches and other health system factors (level of healthfacility, cadre of staff conducting the delivery, years of experienceof staff conducting the delivery, and time of day) on the quality ofsix elements of delivery and postpartum/postnatal care.Design: Cross-sectional study using external observers. Setting: 12 public health facilities in 6 states in India duringNovember 2014.Participants/patients: 461 deliveries in above facilities.Intervention: Facilities were chosen based on having receivedone day of QI training and at least six monthly QI coaching visits.Main Outcome Measure(s): (i) Administration of oxytocin withinone minute following delivery, (ii) immediate drying and wrappingof the newborn, (iii) use of sterile cord clamps, (iv) breastfeedingwithin one hour of birth, (v) mothers’ condition assessed between0 and 30 minute after delivery, and (vi) vitamin K given to infantswithin 6 hour of birth.Results: On multivariate analysis, facilities using QI approacheswith deliberate aims to address the processes of interest weremore likely to dry and wrap infants (OR 2.6, 95% CI: 2.1, 6.6),initiate early breastfeeding (OR 3.6, 95% CI: 2.1, 6.2) and conductpost-partum vitals monitoring (OR 2.7, 95% CI: 1.7, 4.2). Theother health system factors had mixed effects.Conclusions: Facilities using QI approaches to ensure all womenand babies receive specific elements of care provide that elementof care to a greater proportion than facilities not using QIapproaches for that element of care.