Acceptability and Applicability of Simplified Case Sheets in Improving the Quality of Maternal and Neonatal Healthcare in Primary Health Centers of Northern Karnataka, India

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Karnataka has highest MMR (178) and second highest neonatal morality (24) in South India. Northern Karnataka is more rural and resource-constrained has higher rates within the state. BMGF funded Sukshema project provided technical assistance to Karnataka National Health Mission to improve maternal and neonatal health through innovative nurse mentor model at designated 24/7 primary health centres (PHCs). Nurse Mentors focussed on clinical mentoring of staff nurses to improve quality of MNCH services. A critical component of this innovation was the “simplified case sheet” which serves as a job-aid for nurses conducting deliveries in PHCs and is a quality of care monitoring tool.

Methodology: Case sheet summary (CSS) and case sheet audit (CSA) were used to assess acceptability and application of case sheets in 379 target facilities. Acceptability of case sheets was defined as a trend in the use of case sheets for patients in the facilities over time. Application was defined as the trend in whether essential care procedures such as documentation of partograph, AMTSL administration, etc were done. Case sheet summary data is available for the period of March 2013 to November 2014 and case audit data from April to November 2014.

Results: Acceptability: over study period (twenty month), normal delivery case sheet usage improved from 36.4 % to 86.9% and complication sheet from 15.4% to 71%. Application: correct documentation of partograph improved from 80.2% in April 2014 to 91.1% in November 2014, AMTSL administration improved from 96.2% to 99.2%, Vitamin-K administration to neonates improved from 66.2% to 80.2%. Similarly linkages with front-line workers for initiating postpartum care improved from 79.8% to 88.8%.

Conclusion: These simplified normal delivery and complication case sheets as a job-aid and monitoring tool when scaled up to all PHCs within the public health system can enhance quality of critical maternal and neonatal management.